Need Only Two Choices “ Palliative or terminal sedation” Control otherwise untreatable symptoms “ Sedation” All other types of sedation No consensus yet – describing your viewpoint will help clarify the issue Īttitudes The cultural background determines attitudes, viewpoints on goals of care, and in which situations of 'intolerable suffering' sedation is ethically acceptable. Attitudes towards terminal sedation: an empirical survey among experts in the field of medical ethics. In all other cases of medically indicated sedation we recommend to speak only of sedation. We recommend to use the terms 'palliative sedation' and 'terminal sedation' as synonyms for treatments aiming to control untreatable symptoms in (pre-)terminal patients by reduction of consciousness. No consistent terminology and no consistent definition of the term In the long run, a more consistent and precise terminology is desirable. It’s a close call… and often the answer changes Preference for the different terms with medical background without medical background “ Sedation at the end of life” 38% 36% “ Palliative sedation” 53% 41% “ Terminal sedation” 32% 46% Conclusion
So Let’s See What The Ethicists Have to Say Since ThenĢ008 - Understanding Terms and Attitudes Survey among experts in the field of medical ethics (German Academy for Ethics in Medicine) 73% of the respondents would only speak of “terminal sedation” when sedation until death is intended 27% would also use the term when the patient is sedated at the time of death, without sedation until death explicitly intended in the first place. 23, 1678-81 īarbiturates Are Justified To relieve physical suffering when all reasonable alternatives have failed To produce unconsciousness before terminal extubation Produce deep sedation and unconsciousness as a means of relieving nonphysical suffering If comfort care is the only intended effect, then Truog, Robert D., et. What can be done?īarbiturates in the Care of The Terminally ill Barbiturates: Reliably produce sedation and unconsciousness ( comfort ) Are used in the execution of prisoners by lethal injection Ethical Considerations: The Principle of Double Effect - Distinction between intended effects and unintended although foreseen effects.
The anesthesia team could not place a catheter due to the large tumor burden.
When this happened, ketamine and Precedex were unavailable. Morphine drip at 1000 mg/hour and no pain relief or sedation. General Concept 1992 - When all else fails: 17 year old girl with relapsed Ewing's sarcoma, multiple bony metastases, pelvic mass compressing her spine and causing bilateral leg paralysis, constant severe bone, abdominal, and pelvic pain. Outline What is Terminal Sedation? Nuances & Ethical Decisions How is is Done? Terminal Sedation Compassion Amidst Ethical Uncertainties
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