Walking the Line. Palliative Sedation for Existential Distress: Still a Controversial Issue?

Overview

Journal Wien Med Wochenschr

Specialty General Medicine

Date 2015 Dec 3

PMID 26628315

Citations 3

Authors

Sophie Schur

Lukas Radbruch

Eva K Masel

Dietmar Weixler

Herbert H Watzke

Affiliations

Soon will be listed here.

Abstract

Adequate symptom relief is a central aspect of medical care of all patients especially in those with an incurable disease. However, as an illness progresses and the end of life approaches, physical or psychoexistential symptoms may remain uncontrollable requiring palliative sedation. Although palliative sedation has become an increasingly implemented practice in the care of terminally ill patients, sedation in the management of refractory psychological symptoms and existential distress is still a controversial issue and much debated. This case report presents a patient who received palliative sedation for the treatment of existential distress and discusses considerations that may arise from such a therapeutic approach.

Citing Articles

Intercountry and intracountry variations in opinions of palliative care specialist physicians in Germany, Italy, Japan and UK about continuous use of sedatives: an international cross-sectional survey.

Morita T, Kawahara T, Stone P, Sykes N, Miccinesi G, Klein C BMJ Open. 2022; 12(4):e060489.

PMID: 35459681 PMC: 9036469. DOI: 10.1136/bmjopen-2021-060489.

Reflections on palliative sedation.

Twycross R Palliat Care. 2019; 12:1178224218823511.

PMID: 30728718 PMC: 6350160. DOI: 10.1177/1178224218823511.

[In Process Citation].

Weixler D Wien Med Wochenschr. 2015; 165(23-24):465-6.

PMID: 26597216 DOI: 10.1007/s10354-015-0405-2.

References

Morita T, Tsunoda J, Inoue S, Chihara S . Terminal sedation for existential distress. Am J Hosp Palliat Care. 2002; 17(3):189-95. DOI: 10.1177/104990910001700313. View

Rousseau P . Existential distress and palliative sedation. Anesth Analg. 2005; 101(2):611-612. DOI: 10.1213/01.ANE.0000159014.71321.A2. View

de Graeff A, Dean M . Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med. 2007; 10(1):67-85. DOI: 10.1089/jpm.2006.0139. View

Muller-Busch H, Andres I, Jehser T . Sedation in palliative care - a critical analysis of 7 years experience. BMC Palliat Care. 2003; 2(1):2. PMC: 165435. DOI: 10.1186/1472-684X-2-2. View

Rietjens J, van Zuylen L, van Veluw H, van der Wijk L, van der Heide A, van der Rijt C . 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(3):228-34. DOI: 10.1016/j.jpainsymman.2007.10.014. View

Barbera L, Seow H, Howell D, Sutradhar R, Earle C, Liu Y . Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer. 2010; 116(24):5767-76. DOI: 10.1002/cncr.25681. View

Rietjens J, van der Heide A, Vrakking A, Onwuteaka-Philipsen B, van der Maas P, van der Wal G . Physician reports of terminal sedation without hydration or nutrition for patients nearing death in the Netherlands. Ann Intern Med. 2004; 141(3):178-85. DOI: 10.7326/0003-4819-141-3-200408030-00006. View

Cherny N, Radbruch L . European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med. 2009; 23(7):581-93. DOI: 10.1177/0269216309107024. View

Maltoni M, Scarpi E, Rosati M, Derni S, Fabbri L, Martini F . Palliative sedation in end-of-life care and survival: a systematic review. J Clin Oncol. 2012; 30(12):1378-83. DOI: 10.1200/JCO.2011.37.3795. View

10.

Kirk T, Mahon M . National Hospice and Palliative Care Organization (NHPCO) position statement and commentary on the use of palliative sedation in imminently dying terminally ill patients. J Pain Symptom Manage. 2010; 39(5):914-23. DOI: 10.1016/j.jpainsymman.2010.01.009. View

11.

Ventafridda V, Ripamonti C, De Conno F, Tamburini M, Cassileth B . Symptom prevalence and control during cancer patients' last days of life. J Palliat Care. 1990; 6(3):7-11. View

12.

Dean M, Cellarius V, Henry B, Oneschuk D, Librach Canadian Society Of Palliative Care Physicians Taskforce S . Framework for continuous palliative sedation therapy in Canada. J Palliat Med. 2012; 15(8):870-9. DOI: 10.1089/jpm.2011.0498. View

13.

Cherny N, Portenoy R . Sedation in the management of refractory symptoms: guidelines for evaluation and treatment. J Palliat Care. 1994; 10(2):31-8. View

14.

Fainsinger R, Miller M, Bruera E, Hanson J, MacEachern T . Symptom control during the last week of life on a palliative care unit. J Palliat Care. 1991; 7(1):5-11. View

15.

Kutner J, Bryant L, Beaty B, Fairclough D . Time course and characteristics of symptom distress and quality of life at the end of life. J Pain Symptom Manage. 2007; 34(3):227-36. DOI: 10.1016/j.jpainsymman.2006.11.016. View

16.

Teunissen S, Wesker W, Kruitwagen C, de Haes H, Voest E, de Graeff A . Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage. 2007; 34(1):94-104. DOI: 10.1016/j.jpainsymman.2006.10.015. View

17.

Penner J . Psychosocial care of patients with head and neck cancer. Semin Oncol Nurs. 2009; 25(3):231-41. DOI: 10.1016/j.soncn.2009.05.008. View

18.

Schuman Z, Abrahm J . Implementing institutional change: an institutional case study of palliative sedation. J Palliat Med. 2005; 8(3):666-76. DOI: 10.1089/jpm.2005.8.666. View

19.

Fainsinger R, Landman W, Hoskings M, Bruera E . Sedation for uncontrolled symptoms in a South African hospice. J Pain Symptom Manage. 1998; 16(3):145-52. DOI: 10.1016/s0885-3924(98)00066-9. View

20.

Luckett T, Britton B, Clover K, Rankin N . Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature. Support Care Cancer. 2011; 19(7):871-81. DOI: 10.1007/s00520-011-1119-7. View