Addressing challenges with sedation in end-of-life care Editorial
| Authors: | Thomas, C.; Alici, Y.; Breitbart, W.; Bruera, E.; Blackler, L.; Sulmasy, D. P. |
| Title: | Addressing challenges with sedation in end-of-life care |
| Abstract: | In 2009, Quill and colleagues stipulated that there are three types of sedation practices at the end of life: ordinary sedation, proportionate palliative sedation (PPS), and palliative sedation to unconsciousness (PSU). Of the three, PPS and PSU are described as “last-resort options” to relieve refractory symptoms, and PSU as the most ethically controversial type that “should be quite rare.” Unfortunately, little is known about actual sedation practices at the end of life in the United States. This may be due in part to a lack of conceptual clarity about sedation in end-of-life care. We argue that, until more is known about what sedation practices occur at the end of life, and how practices can be improved by research and more specific guidelines, “palliative sedation” will remain more misunderstood and controversial than it might otherwise be. In our view, overcoming the challenges posed by sedation in end-of-life care requires: 1) greater specificity regarding clinical situations and approaches to sedation, 2) research tailored to focused clinical questions, and 3) improved training and safeguards in sedation practices. Terms like PPS and PSU are relatively simple to understand in the abstract, but their application comprises various clinical situations and approaches to sedation. An obvious barrier to empirical research on sedation practices in end-of-life care is the challenge of determining these elements, especially if not clearly communicated. Additionally, we argue that training for palliative care specialists and others should include monitoring and rescue techniques as required competencies. © 2023 American Academy of Hospice and Palliative Medicine |
| Keywords: | united states; palliative care; delirium; palliative therapy; sedation; practice guideline; death; training; research; medical specialist; terminal care; end-of-life care; ethics; palliative sedation; empirical research; unconsciousness; humans; human; article; richmond agitation sedation scale |
| Journal Title: | Journal of Pain and Symptom Management |
| Volume: | 67 |
| Issue: | 4 |
| ISSN: | 0885-3924 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-04-01 |
| Start Page: | 346 |
| End Page: | 349 |
| Language: | English |
| DOI: | 10.1016/j.jpainsymman.2023.12.016 |
| PUBMED: | 38158164 |
| PROVIDER: | scopus |
| PMCID: | PMC10939822 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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