PALLIATIVE SEDATION AT THE END OF LIFE
Effective control of symptoms can be achieved under most con-ditions, but some patients may experience distressing, intractable symptoms. Although its use remains controversial, palliative se-dation is offered in some settings to patients who are close todeath, who have symptoms that do not respond to conventional pharmacologic and nonpharmacologic approaches, and as a re-sult are experiencing unrelieved suffering. Palliative sedation is distinguished from euthanasia or physician-assisted suicide in that the intent of palliative sedation is to palliate the symptoms, not to hasten the patient’s death. Palliative sedation is most com-monly used when the patient exhibits intractable pain, dyspnea, seizures, or delirium. It is generally considered appropriate in only the most difficult cases. Before implementing palliative se-dation, the care team should assess for the presence of underlying and treatable causes of suffering, such as depression or spiritual pain. Finally, patients and families should be fully informed about the use of this treatment and alternatives.
Palliative sedation is accomplished through infusion of a ben-zodiazepine or barbiturate in doses adequate to induce sleep and eliminate signs of discomfort (Quill & Byock, 2000). The nurse acts as a collaborating member of the interdisciplinary team, pro-viding emotional support to the patient and family, facilitating clarification of values and preferences, and providing comfort-focused physical care. Once sedation has been induced, the nurse will need to continue comfort care, monitor the physiologic ef-fects of the sedation, support the family during the final hours or days of the patient’s life, and ensure communication within the care team and between the team and family.
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