Palliative Sedation in Patients With Terminal Illness

Excerpt

Palliative sedation encompasses a broad range of activities aimed at relieving distress in terminally ill patients. Palliative sedation involves therapy to resolve or alleviate refractory symptoms at the end of life. The most common refractory symptoms in terminally ill patients are delirium, intractable pain, and shortness of breath. There is a well-established practice and relative acceptance of the use of palliative sedation to relieve these symptoms. However, there is still open controversy and ethical debate about the use of palliative sedation for the relief of existential or psychological distress in terminally ill patients.

Some controversy arises over a lack of consistency in defining "refractory symptoms" and a lack of adequate knowledge among patients, family members, and healthcare workers alike regarding the issue of palliative sedation. Additionally, ethical and legal issues surrounding this topic, as it appears, at least superficially similar to the process of physician-assisted suicide or euthanasia, discourage physicians from initiating conversations or planning for palliative sedation in patients. For clarity, the goal of palliative sedation is truly aimed at sedation, not a cessation of life, and studies have shown that palliative sedation overall is not associated with a shortened life span. Also, one of the guiding principles of palliative sedation is that it is applied when the anticipated life span of a terminally ill patient is in the range of hours to days.

Prior studies have demonstrated several communication barriers between clinicians, patients, and surrogates that prevent timely planning for end-of-life issues, leading to increased anxiety and frustrations towards the medical team. Furthermore, several misconceptions remain among patients and their families regarding palliative care issues, including hospice, pain control, and palliative sedation. This review discusses the indications for palliative sedation, legal/ethical dynamics associated with its use, common misconceptions, and pharmacological agents used.