Palliative sedation to alleviate existential suffering at end-of-life: Insight into a controversial practice

Kim Sadler

Abstract


All terminally ill individuals should have access to palliative care that gives equal importance to all aspects of suffering. In spite of all the efforts made, some of these individuals will, unfortunately, be left with suffering described as “refractoryâ€. It would appear that palliative sedation then becomes an option. There is much controversy around this practice, especially when it is used to alleviate suffering of a more existential nature. This article aims first to define the practice of palliative sedation, second to explore the concept of existential suffering in palliative care and third to address the implications for nursing practice.


Full Text:

PDF

References


APES (2008). Guide pratique des soins palliatifs : gestion de la

douleur et autres symptômes (4ème éd.). Montréal : Association des

pharmaciens des établissements de santé du Québec (APES).

Blinderman, C.D., & Cherny, N.I. (2005). Existential issues do not

necessarily result in existential suffering: Lessons from cancer

patients in Israel. Palliative medicine, 19, 371–380.

Block, S.D. (2000). Assessing and managing depression in terminally

ill patients. Annals of Internal Medicine, 132(3), 209–218.

Blondeau, D., Roy, L., Dumont, S., Godin, G., & Martineau, I. (2005).

Physicians’ and pharmacists’ attitudes toward the use of sedation

at the EOL: Influence of prognosis and type of suffering. Journal

of Palliative Care, 21(4), 238–245.

Bruce, A., & Boston, P. (2011). Relieving existential suffering through

palliative sedation: Discussion of an uneasy practice. Journal of

Advanced Nursing, 67(12), 2732–2740.

Cassel, E.H. (1982). The nature of suffering and the goals of

medicine. New England Journal of Medicine, 306, 639–645.

Cherny, N.I., Coyle, N., & Foley, K.M. (1994). Suffering in the advanced

cancer patient: A definition and taxonomy. Journal of Palliative

Care, 10, 57–70.

Chochinov, H.M. (2006). Dying, dignity, and new horizons in

palliative end-of-life care. CA Cancer Journal for Clinicians, 56,

–103.

Cohen, J.S., & Erickson, J.M. (2006). Ethical dilemmas and moral

distress in oncology nursing practice. Clinical Journal of Oncology

Nursing, 10(6), 775–779.

Crenshaw, J. (2009). Palliative sedation for existential suffering.

Journal of Hospice and Palliative Nursing, 11(2), 101–106.

De Graeff, A., & Dean, M. (2007). Palliative sedation therapy in the

last weeks of life: A litterature review and recommendations for

standards. Journal of Palliative Medicine, 10(1), 67–85.

Jameton, A. (1984). Nursing practice: The ethical issues. Englewood

Cliffs. NJ: Prentice Hall.

Kearny, M. (2000). A place of healing: Working with suffering in living

and dying. Oxford: Oxford University Press.

Kissane, D.W., Clarke, D.M., & Street, A.F. (2001). Demoralization

syndrome—A relevant psychiatric diagnosis for palliative care.

Journal of Palliative Care, 17, 12–21.

Lo, B., & Rubenfeld, G. (2005). Palliative sedation in dying patients:

“We turn to it when everything else hasn’t workedâ€. JAMA,

(14), 1810–1816.

Maltoni, M., Pittureri, C., Scarpi, E., Piccinini, L., Martini, F., Turci,

P., et al. (2009). Palliative sedation therapy does not hasten

death: Results from a prospective multicenter study. Annals of

Oncology, 20(7), 1163–1169.

McIntyre, A. (2004). The double life of double effect. Theoretical

Medicine and Bioethics, 25, 61–74.

Morita, T., Tsudona, J., Inoue, S., & Chihara, S. (2000). Terminal

sedation for existential distress. American Journal of Hospice

and Palliative Medicine, 17(3), 189–195.

Morita, T., Tsuneto, S., & Shima, Y. (2002). Definition of sedation for

symptom relief: A systematic literature review and a proposal of

operational criteria. Journal of Pain and Symptom Management,

(4), 447–453.

Morita, T. (2003). Ethical validity of palliative sedation therapy

(letter to the editor). Letters, 25(2), 103–104.

Morita, T. (2004a). Palliative sedation to relieve psycho-existential

suffering of the terminally ill cancer patients. Journal of pain and

symptom management, 28(5), 445–450.

Morita, T., Miyashita, M., Kimura, R., Adachi, I., & Shima, Y. (2004b).

Emotional burden of nurses in palliative sedation therapy.

Palliative Medicine, 18, 550–557.

Muller-Bush, H.C., Andres, I., & Jehser, T. (2003). Sedation in

palliative care—A critical analysis of 7 years experience. BMC

Palliative Care, 2(2).

National Ethics Committee, Veterans Health Administration. (2007).

The ethics of palliative sedation as a therapy of last resort.

American J of Hospice and Palliative Medicine, 23(6), 483–491.

Quill, T.E., & Byock, I.R. (2000). Responding to intractable terminal

suffering: The role of terminal sedation and voluntary refusal of

food and fluids. Annals of Internal Medicine, 132(5), 408–414.

Rady, M.Y., & Verheijde, J.L. (2010). Continuous deep sedation until

death: Palliation or physician-assisted death. American Journal

of Hospice and Palliative Care, 27(3), 205–214.

Rietjens, J.A., van der Heide, A., Vrakking, A.M., Onwuteaka-

Philipsen, B.D., van der Maas, P.J., & van der Wal, G. (2004).

Physician reports of terminal sedation without hydration or

nutrition for patients nearing death in Netherlands. Annals of

Internal Medicine, 141(3), 178–185.

Riejens, J.A., Buiting, H.M., Pasman, H.R.W., van der Maas, P.J.,

van Delden, J.J.M. & van der Heide, A. (2009). Deciding about

continuous deep sedation: Physicians’ perspectives—A focus

group study. Palliative Medicine, 23, 410–417.

Rodriguez c. Colombie-Britannique (Procureur général), [1993] 3 RCS

Rousseau, P. (2001). Existential suffering and palliative sedation: A

brief commentary with a proposal for guidelines. American J of

Hospice and Palliative Care, 18(3), 151–153.

Saunders, C. (1988). Spiritual pain. Journal of Palliative Care, 4, 29–

Schuman-Olivier, Z., Brendel, D.H., Forstein, M., & Price, B.H.

(2008). The use of palliative sedation for existential distress:

A psychiatric perspective. Harvard Review of Psychiatry, 16(6),

–351.


Refbacks

  • There are currently no refbacks.