Consensus guidelines on analgesia and sedation in dying intensive care unit patients.
BACKGROUND
Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia.


METHODS
Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12).


RESULTS
After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU.


CONCLUSIONS
Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.
Hawryluck
Laura A
LA
Ian Anderson Continuing Education Program In End of Life Care, Toronto; Canada. laura.hawryluck@utoronto.ca
Harvey
William R C
WR
Lemieux-Charles
Louise
L
Singer
Peter A
PA
D000700:Analgesics / Q000627:therapeutic use*; D032921:Consensus; D028601:Euthanasia, Active; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007362:Intensive Care Units; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods* / Q000592:standards*; D017410:Practice Guidelines as Topic; D013315:Stress, Psychological / Q000188:drug therapy; D017236:Suicide, Assisted; D013727:Terminal Care / Q000592:standards*; D019452:Terminally Ill
D000700:Analgesics; D006993:Hypnotics and Sedatives
Death and Euthanasia; Empirical Approach