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- Title
Last-Resort Options for Palliative Sedation.
- Authors
Quill, Timothy E.; Lo, Bernard; Brock, Dan W.; Meisel, Alan
- Abstract
Despite receiving state-of-the-art palliative care, some patients still experience severe suffering toward the end of life. Palliative sedation is a potential way to respond to such suffering, but access is uneven and unpredictable, in part because of confusion about different kinds of sedation. Proportionate palliative sedation (PPS) uses the minimum amount of sedation necessary to relieve refractory physical symptoms at the very end of life. To relieve suffering may require progressive increases in sedation, sometimes to the point of unconsciousness, but consciousness is maintained if possible. Palliative sedation with the intended end point of unconsciousness (PSU) is a more controversial practice that may be considered for much fewer refractory cases. There is more ethical consensus about PPS than PSU. In this article, the authors explore the clinical, ethical, and legal issues associated with these practices. They recommend that palliative care and hospice programs develop clear policies about PPS and PSU, including mechanisms for training and ensuring competency for clinicians, and approaching situations where individuals or institutions may conscientiously object.
- Subjects
PALLIATIVE treatment; TERMINAL sedation; LOSS of consciousness; HOSPICE care; SERVICES for older people
- Publication
Annals of Internal Medicine, 2009, Vol 151, Issue 6, p421
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/0003-4819-151-6-200909150-00007