Palliative sedation: Clinical practice challenges in Mexico and development of a national protocol for Mexico

Abstract

Fuente (2015) Palliative sedation: Clinical practice challenges in Mexico and development of a national protocol for Mexico, Progress in Palliative Care, 23:5, 274-280To link to this article: http://dx.Background: Palliative sedation (PS) involves the administration of sedative medications and analgesics with the purpose of reducing level of consciousness for patients with refractory suffering in the setting of imminent dying and terminal illness. Although the merits of PS, as well as potential concerns, have been raised frequently in the literature in the past two decades, the clinical utilization and acceptance of PS (and of palliative care in general) have been sparse in Mexico. Discussion: As a relatively new treatment option for medical care providers in Mexico, palliative care and the appropriate use of PS are being slowly and cautiously introduced into clinical practice. However, acceptance of the ethical, moral, and legal permissibility of PS remains variable, as is the understanding of appropriate use or integration of palliative care into clinical practice in Mexico. Summary: Given changes to Mexican law that have called for provision of adequate palliative care for all patients in Mexico, and advance care planning laws that allow patients to refuse medical treatments that are not consistent with their goals of care, this paper seeks to frame commonly articulated positions regarding PS, explores these challenges in Mexico, and suggests putative guidelines for safe and appropriate implementation of PS. At the urging the Ministry of Health in Mexico, we present a cogent, evidence-based, and internationally vetted protocol outlining the indications for PS and suggested clinical practice guidelines for safe and effective implementation of PS in Mexico for appropriate patients.

Expert-approved best practice recommendations on the use of sedative drugs and intentional sedation in specialist palliative care (SedPall)

“…Only propofol, a narcotic, is not recommended for use in home care because of its smaller therapeutic window and its higher risks compared to midazolam. This is in line with other national and regional recommendations [ 2 , 38 – 40 ].…”

“…The year 1990 saw the first ever publication on sedation in palliative care that discussed patients treated with sedative drugs at home [ 36 ]. This work initiated an ongoing debate around which types of intentional sedation are possible in the home setting; previously published research and recommendations suggest that this depends on characteristics of the specific setting and particularly on the staffing levels specialist teams can provide [ 13 , 20 , 37 , 38 ]. The recommendations we outline here are suitable for use in both inpatient and home care settings.…”

Palliative Sedation—The Last Resort in Case of Difficult Symptom Control: A Narrative Review and Experiences from Palliative Care in Switzerland

“…The challenges in palliative sedation have been described in other cultural contexts before, e.g., reports from the USA, Mexico, Belgium, the Netherlands, Japan, Singapore, Germany and the United Kingdom [25,36,37]. Difficulty in communicating the differences between palliative sedation and physician-assisted suicide or euthanasia seems to be a problem in most countries.…”