title: The use of palliative sedation for existential distress: a psychiatric perspective.
abstract: This article introduces a structure for standardization in the ongoing debate about the application of palliative sedation for psychological and existential suffering at the end of life. We differentiate the phenomenon of existential distress from the more general one of existential suffering, defining existential distress as a special case of existential suffering that applies to persons with terminal illness. We introduce both a clinical classification system of existential distress based on proximity to expected death and a decision-making process for considering palliative sedation (represented by the mnemonic, TIRED). Neuropsychiatric clinical cases will be used to demonstrate some of the concepts and ethical arguments.
authors.affiliation: Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA 02139, USA. zschuman-olivier@cha.harvard.edu
authors.forename: Zev
authors.initials: Z
authors.lastname: Schuman-Olivier
authors.forename: David H
authors.initials: DH
authors.lastname: Brendel
authors.forename: Marshall
authors.initials: M
authors.lastname: Forstein
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Price
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology; D000328:Adult; D000368:Aged; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D020961:Lewy Body Disease / Q000188:drug therapy; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D010166:Palliative Care; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D011570:Psychiatry / Q000941:ethics; D019452:Terminally Ill / Q000523:psychology*
chemical_list: D006993:Hypnotics and Sedatives