Sedation in palliative care.
OBJECTIVE
Palliative sedation, the conscious induction of sleep in patients with a very short life expectancy who suffer intractable physical and existential distress, may offer the patient and his or her relatives a more peaceful dying. This technique is still subject to several ethical and medical controversies justifying a review of the recent literature on this subject.


RESULTS
The available evidence consists of few prospective trials and mainly retrospectively collected case reports. Two guidelines are published in the period under review. The most important points stressed in these reviews are the careful information exchange with the patient, if possible, and his or her proxies, a gradually increased sedation allowing respite if possible to evaluate the effect of the sedation and the need for consultation with colleagues, preferentially physicians experienced in palliative care. Stopping artificial nutrition and hydration is a medical decision that should be taken after evaluation of the potential side effects and consultation with the patient and relatives.


CONCLUSIONS
Palliative sedation may be considered for terminally ill patients who suffer intractable symptoms. Ideally it should be included in the patient's trajectory that has been described and discussed earlier when the disease was judged to be incurable. The main goal is to offer comfort.
Vissers
Kris C P
KC
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen, The Netherlands. k.vissers@anes.umcn.nl
Hasselaar
Jeroen
J
Verhagen
Stans A H H V M
SA
D000776:Anesthesiology / Q000941:ethics / Q000379:methods*; D006801:Humans; D018529:Nutritional Support / Q000941:ethics / Q000379:methods; D010166:Palliative Care / Q000941:ethics / Q000379:methods*; D019452:Terminally Ill