The Use of Palliative Sedation for Existential Distress: A Psychiatric Perspective

Schuman‐Olivier, Zev; Brendel, David H.; Forstein, Marshall; Price, Bruce H.

doi:10.1080/10673220802576917

Cited by 69 publications

(90 citation statements)

References 55 publications

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“…Common indications for ps include intractable delirium, dyspnea, seizures, and severe pain 2,7 . Controversial indications that have to be evaluated on an individual basis include sedation for psychological or existential suffering 3,8 . Midazolam, administered by continuous infusion, is the drug of choice for ps 1,2,7 .…”

Section: Introductionmentioning

confidence: 99%

Practice and Documentation of Palliative Sedation: A Quality Improvement Initiative

et al. 2014

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ConclusionsThe lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area. KEY WORDSPalliative care, conscious sedation, deep sedation, documentation, hypnotics and sedatives BACKGROUNDPalliative sedation (ps) is the intentional, continuous use of sedative medications with the goal of reducing consciousness and relieving intolerable suffering from refractory symptoms in patients who are at end of life (that is, last hours to days) 1 . A symptom is considered refractory when all possible treatments available within a tolerable time frame and risk-benefit ratio have been tried, but have not been successful 1 . Throughout the literature, the frequency of ps ranges from 2% to 52% depending on setting, research methodology, and definition 2 . Studies show that, when appropriately administered, ps does not invariably hasten death 3 . It is an essential therapy that is ethically justifiable when used appropriately with the intention of relieving intolerable suffering and not shortening life [4][5][6] . Common indications for ps include intractable delirium, dyspnea, seizures, and severe pain 2,7 . Controversial indications that have to be evaluated on an individual basis include sedation for psychological or existential suffering 3,8 . Midazolam, administered by continuous infusion, is the drug of choice for ps 1,2,7 . Other medications include methotrimeprazine and phenobarbital 2,9 .Over the last several years, ps has appropriately received increasing attention, and national and international guidelines have been developed to guide ABSTRACT Background

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Section: Introductionmentioning

confidence: 99%

Practice and Documentation of Palliative Sedation: A Quality Improvement Initiative

et al. 2014

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“…Dans le contexte des soins palliatifs, il semble qu'au moment où toutes les interventions disponibles afin de pallier un symptôme ont échoué, émerge alors une dernière option, celle de la sédation palliative. La séda-tion palliative est ainsi perçue comme une forme de traitement de dernier recours (De Graeff & Dean, 2007;Muller-Bush, Andres, & Jehser, 2003;Quill & Byock, 2000;Schuman-Olivier, Brendel, Forstein, & Price, 2008). Plusieurs propositions de lignes directrices ont été publiées dans le but de rendre cette pratique plus structurée, éthique, justifiée et surtout de la distinguer de celle du suicide assisté et de l'euthanasie.…”

Section: B Depuis Que La Sédation Palliative a éTé Amorcée Elle N'ounclassified

“…La controverse se poursuit malgré le fait que la Cour Suprême des États-Unis ait donné son approbation à la pratique de la séda-tion en 1997 (Schuman-Olivier, Brendel, Forstein, & Price, 2008;Crenshaw, 2009). Lors de deux jugements concernant le suicide assisté (Vacco v. Quill) (Washington v. Glucksberg), la Cour Suprême semble avoir distingué l'utilisation de la sédation palliative du suicide assisté et de plus, l'avoir seule retenue comme pratique acceptable (National Ethics Committee, 2007).…”

Section: La Loiunclassified

“…Dans quelques textes, on a tenté de distinguer la souffrance existentielle de la souffrance plutôt qualifiée de « psychologique » (p. ex. : dépression, anxiété) (Block, 2000;Schuman-Olivier, Brendel, Forstein, & Price, 2008). Ce n'est certes pas le but dans cet article de clarifier de façon exhaustive comment des troubles psychologiques particuliers se présentent en fin de vie, mais il est important de souligner que les frontières sont actuellement mal définies entre une détresse psychologique (p. ex.…”

Section: Souffrance Existentielleunclassified

“…En présence de souffrance existentielle par contraste à une dépression clinique, il est possible que l'individu n'ait pas complètement perdu l'intérêt pour toutes les activités et qu'un sentiment de culpabilité ne soit pas non plus aussi présent. Malgré ces balises, distinguer une dépression d'une détresse existentielle peut s'avérer une tâche ardue (Schuman-Olivier, Brendel, Forstein, & Price, 2008).…”

Section: Dépressionunclassified

See 2 more Smart Citations

La sédation palliative pour soulager la souffrance existentielle en fin de vie : regard sur une pratique controversée

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Does It Matter Whether a Psychiatric Intervention Is “Palliative”?

2023

AMA Journal of Ethics

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Palliative interventions are intended to alleviate suffering and improve quality, not quantity, of life and are not intended to cure illness. In psychiatry, uncertainty about which interventions count as palliative stems from the fact that psychiatry generally prioritizes symptom management irrespective of diagnosis or specific pathophysiology of illness. This commentary on a case considers how distinctions between palliative and other psychiatric interventions might not be all that helpful in resolving clinical and ethical questions about which interventions are-and when they are-appropriate. The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.Case CC is a 40-year-old patient who has experienced multiple shifts in diagnoses over 10 years among mood disorders, substance use disorders, and personality disorders. CC is currently recovering from a 6-year addiction to cocaine and has been involuntarily admitted several times during the last 8 years for self-harm. After just over 1 year of reliable symptom control with an antidepressant, electroconvulsive therapy, and psychotherapy, CC is again experiencing passive suicidal ideation and worsening depression. Dr P worries that CC might attempt suicide or relapse into drug use and wonders whether a new US Food and Drug Administration (FDA)-approved drug for depression and suicidal ideation would help. This drug rapidly reduces suicidal ideation in a matter of hours in some cases, but evidence does not yet reliably indicate how long suicidal ideation is reduced after treatment or whether suicidal ideation reduction is attributable to dissociation and euphoria, for which the drug has become known since it started being used recreationally. CommentaryCases like this one frequently confront psychiatrists and other mental health professionals. They raise important questions about how these practitioners should address severely treatment-refractory symptoms. The case also raises a difficult question about whether an intervention that carries a risk of addiction-since the proposed intervention produces euphoria, which is associated with dependence 1should be used in order to achieve other benefits, such as the reduction of suicidal

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The Use of Palliative Sedation for Existential Distress: A Psychiatric Perspective

Cited by 69 publications

References 55 publications

Practice and Documentation of Palliative Sedation: A Quality Improvement Initiative

Practice and Documentation of Palliative Sedation: A Quality Improvement Initiative

La sédation palliative pour soulager la souffrance existentielle en fin de vie : regard sur une pratique controversée

Does It Matter Whether a Psychiatric Intervention Is “Palliative”?

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