Palliative sedation is regarded as the use of sedation in the terminal phase, for symptoms that are resistant to treatment. The Guidelines for end-of-life care and decision-making by NSW Health say that “Analgesia and sedation should be provided by whatever route is necessary for relief, in proportion with clinical need, and with the primary goal of relieving pain or other unwanted symptoms". 

The decision to give palliative sedation should not be taken lightly, amd is considered to be a last resort. It is considered appropriate for only a small group of patients, and used for example, for intractable symptoms. Establishing that a symptom is intractable (or impossible to control) is the first step in this process, with the associated decision making of vital importance. 

There can often be areas of contention within the multidisciplinary team. These mainly lie with the intention and depth of sedation, and in palliative sedation corresponding with withdrawal of treatment. One example of this, is whether the patient or family are making the request. If palliative sedation is a consideration then perhaps seek advice and support where possible from a specialist palliative care service.

Resources

• The European Association for Palliative care has a Recommended framework for the use of sedation in palliative care
• The Southern Cross Bioethics Institute website provides access to information on bioethical legislation in Australia, much of which is relevant to palliative care. It can be different in each State and Territory, such as the Consent to Medical Treatment and Palliative Care Act 1995 (SA) and the Medical Treatment Act 1994 (ACT).
• The Center for Bioethics, University of Minnesota (US) has a document: End of Life Care: An Ethical Overview 
• End of Life / Palliative Education Resource Centre (EPERC) Fast Facts
  • Controlled Sedation for Refractory Suffering - Part I 
  • Controlled Sedation for Refractory Suffering - Part 2 
• Therapeutic Guidelines - Palliative care (version 3, 2010) are available in some organisations or can be purchased
• NSW Health has produced Guidelines for end-of-life care and decision-making
• The General Medical Council in the UK has produced a guidance for doctors that may be of interest: Treatment and Care Towards the End of Life – Good practice in decision-making.

Related CareSearch pages

Nurses Hub
Communication
Advanced Care Planning
Working with Families
Symptom Management

Clinical Practice / End of Life Care
Symptom management at the end of life

Clinical Practice / Delirium
Pharmacological management

PubMed Topic Search
Palliative Sedation

CareSearch Review Collection
Palliative Sedation

Free Full Text Article

Simon A, Kar M, Hinz J, Beck D. Attitudes towards terminal sedation: an empirical survey among experts in the field of medical ethics. BMC Palliat Care. 2007 Apr 16;6:4.

References

• Marshall CF. Palliative sedation at the end of life. Exploring a conflict of duty. Adv Nurse Pract. 2009 May;17(5):45-6, 48. No Abstract Avalable.
• Claessens P, Menten J, Schotsmans P, Broeckaert B. Palliative sedation: a review of the research literature. J Pain Symptom Manage. 2008 Sep;36(3):310-33. Epub 2008 Jul 25.
• National Ethics Committee, Veterans Health Administration. The ethics of palliative sedation as a therapy of last resort. Am J Hosp Palliat Care. 2006 Dec-2007 Jan;23(6):483-91.
• Levy MH, Cohen SD. Sedation for the relief of refractory symptoms in the imminently dying: a fine intentional line. Semin Oncol. 2005 Apr;32 (2):237-46.
• Lo B, Rubenfeld G. Palliative sedation in dying patients: "we turn to it when everything else hasn't worked". JAMA. 2005 Oct 12;294(14):1810-6.
• Morita T, Tsuneto S, Shima Y. Definition of sedation for symptom relief: a systematic literature review and a proposal of operational criteria. J Pain Symptom Manage. 2002 Oct;24(4):447-53.
• Cowan JD, Walsh D. Terminal sedation in palliative medicine: definition and review of the literature. Support Care Cancer. 2001 Sep;9(6):403-7. 

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This page was created on 27 August 2010
Last updated 27 August 2010*