Analgesia and Sedation in the ICU: The Ethics and Law

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Myths and fears of ethics and the law surrounding the use of opioids and sedatives at the end of life, fears that opioids and sedatives may hasten death—may be the actual cause of death—result in their being withheld just at the time when the patient may need them the most. The challenge of having a clear line distinguishing palliation from euthanasia is particularly acute for healthcare providers in the intensive care unit (ICU) setting where medications to palliate symptoms are often used preemptively in large doses and increased rapidly. The recently developed consensus guidelines on the use of analgesia and sedation in dying ICU patients can provide practical guidance for alleviating pain and distress at the end of life and ensure that the intent to palliate is clear. While some would argue that fears of legal repercussions are exaggerated, any fear stands in the way of adequate pain relief and must be addressed. This paper reviews the guiding ethical and legal principles surrounding the use of opioids and sedatives in dying patients to help dispel any fears that healthcare providers in the ICU may harbor about having their intentions to palliate being misunderstood as intents to euthanize and thus remove one of the barriers to quality of end of life care in the ICU.

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