1Departments of Pain Management and Palliative Medicine
2Palliative Shared Care Team, St. Martin de Porres Hospital, Chiayi, Taiwan, R.O.C.
3Departments of Pain Management and Palliative Care Unit, Chi-Mei Medical Center, Liou-ying Campus, Tainan, Taiwan, R.O.C.
Palliative Sedation (PS) is a widely used medical intervention by sedatives and analgesics to reduce patient’s consciousness to relieve severely intolerable sufferings and refractory symptoms for the terminally ill. The intent of PS is to relieve the burden of patient and to do so in such a manner so to preserve the moral sensibilities of the patient, the medical professionals involved in their care, and concerned family and friends. This article will review the status of the recent applications, indications, concerns of staff and family, and the process of PS (patient’s assessment, obtaining consent, sedative medications, patient’s monitoring, the role of nutrition and hydration and the administration of previous medications). We also discuss the special applications of PS in palliative care settings, such as, in emergency situations, for respite and for psychological distress. The European Association for Palliative Care has developed a 10-item framework that addresses the key clinical issues to be considered when institutions are developing guidelines for PS. We summarize series studies and our experiences, which will be presented in this article separately.
Palliative sedation, Terminally ill, Intolerable suffering, Refractory symptoms
Cherny NI, Portenoy RK.
Sedation in the management of refractory symptoms: guidelines for evaluation and treatment.
J Palliat Care 1994; 10:31.
Anghelescu DL, Hamilton H, Faughnan LG, et al.
Pediatric palliative sedation therapy with propofol: recommendations based on experience in children with terminal cancer.
J Palliat Med 2012; 15:1082.
Pousset G, Bilsen J, Cohen J, et al.
Continuous deep sedation at the end of life of children in Flanders, Belgium.
J Pain Symptom Manage 2011; 41:449.
Kiman R, Wuiloud AC, Requena ML.
End of life care sedation for children.
Curr Opin Support Palliat Care 2011; 5:285.
Reflections on palliative sedation. Palliat Care
Res and Treat. 2019; Narrative Review 1-16.
Morita T, Chinone Y, Ikenaga M, et al.
Efficacy and safety of palliative therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan.
JPSM 2005; 30: 320-328.
Garetto F, Cancelli F, Rossi R, et al.
Palliative sedative for the terminally ill patient.
CNS Drugs 2018; 32: 951-961.
Mercadante S, Porzio G, Valle A, et al.
Home Care Italy Group Palliative sedation in patients with advanced cancer followed at home: a systematic review.
J Pain Symptom Manage. 2011; 41: 754- 60.
Caraceni A, Zecca E, Martini C, et al.
Palliative sedation at the end of life at a tertiary cancer center.
Support Care Cancer. 2012; 20: 1299-307.
Bishop MF, Stephens L, Goodrich M, Byock I.
Medication kits for managing symptomatic emergencies in the home: a survey of common hospice practice.
J Palliat Med 2009; 12:37.
Nauck F, Alt-Epping B.
Crises in palliative care- -a comprehensive approach.
Lancet Oncol 2008; 9:1086.
Maltoni M, Scarpi E, Rosati M, et al.
Palliative sedation in end-of-life care and survival: a (EAPC)’s 10-item framework that addresses the key clinical issues in palliative sedation for the management of refractory physical symptoms at the end of life.- systematic review.
J Clin Oncol 2012; 30:1378.
Beller EM, van Driel ML, McGregor L, et al.
Palliative pharmacological sedation for terminally ill adults.
Cochrane Database Syst Rev 2015; 1:CD010206.
Daly BJ, Thomas D, Dyer MA.
Procedures used in withdrawal of mechanical ventilation.
Am J Crit Care 1996; 5:331.
Campbell ML, Bizek KS, Thill M.
Patient responses during rapid terminal weaning from mechanical ventilation: a prospective study.
Crit Care Med 1999; 27:73.
Wilson WC, Smedira NG, Fink C, et al.
Ordering and administration of sedatives and analgesics during the withholding and withdrawal of life support from critically ill patients.
JAMA 1992; 267:949.
Maeda I, Morita T, Yamaguchi T, et al.
Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity score-weighted analysis of a prospective cohort study.
Lancet Oncol 2016; 17:115.
Rietjens JA, van Zuylen L, van Veluw H, et al.
Palliative sedation in a specialized unit for acute palliative care in a cancer hospital: comparing patients dying with and without palliative sedation.
J Pain Symptom Manage 2008; 36:228.
Schur S, Weixler D, Gabl C, et al.
Sedation at the end of life - a nation-wide study in palliative care units in Austria.
BMC Palliat Care 2016; 15:50.
Distinction between euthanasia and palliative sedation is clear-cut.
J Med Ethics 2020; 46:55.
Tursunov O, Cherny NI, Ganz FD.
Experiences of family members of dying patients receiving palliative sedation.
Oncol Nurs Forum 2016; 43:E226.
Fins JJ, Bacchetta MD, Miller FG.
Clinical pragmatism: a method of moral problem solving.
Kennedy Inst Ethics J 1997; 7:129.
On withholding artificial hydration and nutrition from terminally ill sedated patients.
The debate continues. J Med Ethics 1996; 22:147.
Review of palliative sedation and its distinction from euthanasia and lethal injection.
J Pain Palliat Care Pharmacother 2012; 26:30.
Higgins PC, Altilio T.
Palliative sedation: an essential place for clinical excellence.
J Soc Work End Life Palliat Care 2007; 3:3.
Ziegler S, Merker H, Schmid M, Puhan MA.
The impact of the inpatient practice of continuous deep sedation until death on healthcare professionals’ emotional well-being: a systematic review.
BMC Palliat Care 2017; 16:30.
Leboul D, Aubry R, Peter JM, et al.
Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study.
BMC Palliat Care 2017; 16:25.
Feldman HA, McKinlay JB, Potter DA, et al.
Nonmedical influences on medical decision making: an experimental technique using videotapes, factorial design, and survey sampling.
Health Serv Res 1997; 32:343.
Christakis NA, Asch DA.
Biases in how physicians choose to withdraw life support.
Lancet 1993; 342:642.
Mercadante S, Porzio G, Valle A, et al.
Palliative sedation in patients with advanced cancer followed at home: a prospective study.
J Pain Symptom Manage 2014; 47:860.
Krakauer EL, Penson RT, Truog RD, et al.
Sedation for intractable distress of a dying patient: acute palliative care and the principle of double effect.
Oncologist 2000; 5:53.
Difficult pain problems: An integrated approach for terminal illnesses. In Wong JON et al
Pain Assessment and Management for Terminally Ill Patients.
Taiwan Academy of Hospice Palliative Medicine and Ho-Chi Publishing Co., Ltd. 2017: pp 229-258.
Morita T, Inoue S, Chihara S.
Sedation for symptom control in Japan: the importance of intermittent use and communication with family members.
J Pain Symptom Manage 1996; 12:32.
Taylor BR, McCann RM.
Controlled sedation for physical and existential suffering?
J Palliat Med 2005; 8:144.
Ciancio AL, Mirza RM, Ciancio AA, et al.
The use of palliative sedation to treat existential suffering: A scoping review on practices, ethical considerations, and guidelines.
J Palliat Care 2020; 35:13.
Voeuk A, Nekolaichuk C, Fainsinger R, et al.
Continuous palliative sedation for existential distress? A survey of Canadian palliative care physicians’ views.
J Palliat Care 2017; 32:26.
Cherny NI, Radbruch L, Board of the European Association for Palliative Care.
European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care.
Palliat Med 2009; 23:581. 29. Ziegler S, Merker H, Schmid M, Puhan MA. The impact of the inpatient practice of continuous deep sedation until death on healthcare professionals’ emotional well-being: a systematic review. BMC Palliat Care 2017; 16:30. 30. Leboul D, Aubry R, Peter JM, et al. Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study. BMC Palliat Care 2017; 16:25. 31. Feldman HA, McKinlay JB, Potter DA, et al. Nonmedical influences on medical decision making: an experimental technique using videotapes, factorial design, and survey sampling. Health Serv Res 1997; 32:343. 32. Christakis NA, Asch DA. Biases in how physicians choose to withdraw life support. Lancet 1993; 342:642.