Total Sedation in End-of-Life Care: Clinical Considerations

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Abstract

PURPOSE.

A summary of essential and practical matters regarding pharmacologically induced reduction of patient awareness to obviate otherwise intractable symptoms of overwhelming distress and suffering that may afflict certain patients in the final stage of far advanced disease.

DATA SOURCES.

Literature review, National Hospice and Palliative Care Organization Ethics Committee Task Force on Total Sedation, and clinical experience.

CONCLUSIONS.

Prevalence of indications for total sedation may vary considerably. Given the probability of encountering patients with overwhelming physical, emotional, or spiritual distress that is poorly relieved by other means, hospice and palliative care providers should be familiar with the ethical tenets and clinical management of deep sedation.

IMPLICATIONS FOR PRACTICE.

Firm grounding in the ethical ramifications, indications for the full range of therapies, and all available management strategies for patients with intractable suffering at end of life who opt for deep sedation is requisite for competency in end-of-life care.

Search terms:

Sedation, suffering, terminal care

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