Palliative Sedation

Palliative sedation is regarded as the use of sedation until death in the terminal phase, for symptoms that are resistant to other treatment measures. [1]

The decision to prescribe and/or administer palliative sedation should not be taken lightly, and is considered to be a last resort once all other measures have been exhausted. 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 collaborative decision making of vital importance.

Making this decision may create debate and contention within the multidisciplinary team. This mainly lies with the intention and depth of sedation, and in palliative sedation corresponding with withdrawal of other treatment. One example of this is whether the patient or family are making the request.

It is important to emphasise that palliative sedation does not have the intent to directly hasten or end life, although some argue that the lines between palliative sedation and euthanasia can be blurred in cases where sedation is introduced too early or if medication doses are disproportionately high. [2] Another study found a lack of consensus in defining ‘existential suffering’ due to its subjective nature and therefore difficulty in deciding on an appropriate treatment course. [3]

If palliative sedation is a consideration then seek advice and support where possible from a specialist palliative care service.

  1. Bruinsma S, Rietjens J, van der Heide A. Palliative sedation: a focus group study on the experiences of relatives. J Palliat Med. 2013 Apr;16(4):349-55. Epub 2013 Feb 19.
  2. Anquinet L, Raus K, Sterckx S, Smets T, Deliens L, Rietjens JA. Similarities and differences between continuous sedation until death and euthanasia - professional caregivers' attitudes and experiences: a focus group study. Palliat Med. 2013 Jun;27(6):553-61. Epub 2012 Oct 26.
  3. Bruce A, Boston P. Relieving existential suffering through palliative sedation: discussion of an uneasy practice. J Adv Nurs. 2011 Dec;67(12):2732-40. Epub 2011 Jun 1.

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Relevant Studies

Websites

  • 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

Guidelines / Documents / Factsheets

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Last updated 14 February 2017