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This medical is about palliative sedation, a medical procedure used in hospice and palliative care to manage severe symptoms that are not responsive to other treatments. It involves the use of medication to induce sedation and unconsciousness in a patient who is near the end of life, in order to alleviate their distress and improve their quality of life.

Palliative sedation is not intended to hasten death, but rather to provide comfort and relief to patients who are suffering from symptoms such as pain, agitation, or breathlessness. The goal is to provide a peaceful and comfortable end-of-life experience for the patient, and to support their family and caregivers during this difficult time.

Palliative sedation should only be used when other treatments have been tried and failed, and when the patients symptoms are causing significant distress and cannot be managed by other means. The decision to use palliative sedation should be made in consultation with the patient, their family, and the healthcare team, and should take into account the patients values and preferences.

The process of palliative sedation involves gradually increasing doses of medication to achieve the desired level of sedation. The medications used may include opioids, benzodiazepines, or other sedatives, and they are typically given by injection or infusion. The patient is closely monitored during the procedure to ensure that they are comfortable and not experiencing any adverse effects.

Palliative sedation is a controversial topic in some circles, and there are concerns about the potential risks and ethical implications of the procedure. Some critics argue that palliative sedation may hasten death or undermine the patients autonomy and dignity. However, advocates of palliative sedation argue that it can be an important tool for relieving suffering and improving the quality of life for patients at the end of life.

Overall, palliative sedation is a complex medical intervention that should be used judiciously and with careful consideration of the patients needs and wishes. It should be seen as a last resort for managing severe symptoms that cannot be controlled by other means, and should always be administered in a compassionate and respectful manner.

Tags : Palliative Sedation, Hospice and Palliative Care, Hospice and Palliative Medicine

Published on : Jun 01, 2023 | Views : 922 | Downloads : 0

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Slide 1-

Palliative Sedation in Hospice and Palliative Care Instructions for using this presentation: Download and save the file to your computer. Review the speaker notes at the bottom of each slide. If needed, copy the speaker notes into another document for reformatting and ease of use during presentation
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Palliative Sedation in Hospice and Palliative Care National Hospice and Palliative Care Organization Ethics Committee July 2012
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Goals Define palliative sedation Discuss ethical justification Discuss implementation issues Review relevant organizational policies and procedures Explore process using case studies
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Define PST Palliative sedation is lowering of patient consciousness using sedative medications; with the intent of limiting patient awareness of suffering; when suffering is otherwise intractable and intolerable (Morita et al., 2002; Kirk & Mahon, 2010).
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Process and Conditions of Sedation Use of sedatives via evidence-based protocol (Cherny et al.) Appropriateness considering patient’s trajectory toward death Proportionate sedation: only to the degree necessary to make suffering tolerable as defined by patient Reversible
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Ethical Justification Nonmaleficence Do no harm Preventing/reducing harm Beneficence Benefitting patient/family Conceive of “benefit” in a way informed by patient/family values/goals Autonomy Honoring wishes/preferences of patient/family Removing barriers/threats to patient’s sense of self
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Confusion about Ethical Justification Assisted suicide debate Doctrine of double effect Sedation & the proximate cause of death Distinct from high-dose opioid use
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Ethical Implementation Thoughtfully and thoroughly developed policy and procedures Rigorous interdisciplinary assessment Excellent but unsuccessful interdisciplinary interventions prior to initiation Clear communication with patient and family Careful, expert implementation Accurate and complete documentation
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Clinical Use Far end of palliative care continuum Part of interdisciplinary plan of care Revocable Only for unrelieved symptoms
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Pediatric Considerations Appropriate for children Unrelieved distress Inadequately alleviated by other measures
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Artificial Nutrition and Hydration Separate the decision for sedation from ANH and other concomitant therapies Consider clinical appropriateness for each intervention Patients have right to refuse invasive procedures Hospice and palliative care organizations have responsibility to offer only therapies consistent with their mission, scope of practice, expertise, and policies and procedures
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Who Decides? Patient: autonomy and related rights Family: involved in care planning Interdisciplinary team: develops care plan with patient and family Advice from external ethics consultation may be helpful Advice from external clinicians may be helpful
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When Death is not Imminent Relationship of sedation and voluntary intake of food & hydration Does sedation preventing intake of food & hydration for >10 days become contributing cause of death? Questions to consider: Voluntary intake? Benefit/burden? Temporary sedation appropriate?
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Organizational Policy and Procedure POLICY Definition of PST Indications for PST Clinical & ethical rationale for PST Guidelines for patient, family, & team assessment & support during and after PST Guidelines for annual case review & quality improvement process
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Organizational Policy and Procedure PROCEDURES Checklist for intractable & intolerable symptoms & trialed/failed interventions Checklist for patient/family education/consent Plan/rationale for continuing/not continuing ANH Evidence-based protocol for selection & dosage of sedative medication
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Organizational Policy and Procedure PROCEDURES Checklist for ongoing support of family and team during sedation Evidence-based protocol for symptom assessment during induction, & regular assessment during sedation to ensure level of suffering is tolerable
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Case Studies Case 1: Mr. Martin, 73-years old, has prostate ca. Case 2: Ms. North is 68 and has lung ca. Case 3: Ms. Smith is 22 years old and has a peripheral neuroectodermal tumor that responded poorly to treatment. Case 4: Mr. George is in his late 50s and has ALS. Case 5: Ms. Lopez is in her mid-30s and has cervical ca that has become metastatic to multiple organs and to bone.
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Bibliography Cherny, N & Radbruch, L. “European Association for Palliative Care (EAPC) Recommended Framework for the Use of Sedation in Palliative Care.” Palliative Medicine 23, no. 7 (2009): 581-593. Kirk, T. & Mahon, M. “National Hospice and Palliative Care Organization (NHPCO) Position Statement and Commentary on the Use of Palliative Sedation in Imminently Dying Terminally Ill Patients.” Journal of Pain & Symptom Management 39, no. 5 (2010): 914-923.
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Bibliography Maltoni, M., Scarpi, E., Rosati, M. et al. “Palliative Sedation in End-of-Life Care and Survival: A Systematic Review.” Journal of Clinical Oncology 30, no. 12 (2012): 1378-1383. Morita, T., Tsuneto, S. & Shima, Y. “Definition of Sedation for Symptom Relief: A Systematic Literature Review and a Proposal of Operational Criteria.” Journal of Pain & Symptom Management 24, no. (2002): 447-453.