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


