title: Ethical decision making with end-of-life care: palliative sedation and withholding or withdrawing life-sustaining treatments.
abstract: Palliative sedation (PS) is the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. Although uncommon, some patients undergoing aggressive symptom control measures still have severe suffering from underlying disease or therapy-related adverse effects. In these circumstances, use of PS is considered. Although the goal is to provide relief in an ethically acceptable way to the patient, family, and health care team, health care professionals often voice concerns whether such treatment is necessary or whether such treatment equates to physician-assisted suicide or euthanasia. In this review, we frame clinical scenarios in which PS may be considered, summarize the ethical underpinnings of the practice, and further differentiate PS from other forms of end-of-life care, including withholding and/or withdrawing life-sustaining therapy and physician-assisted suicide and euthanasia.
authors.affiliation: Division of General Internal Medicine, Palliative Medicine Program, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Molly L
authors.initials: ML
authors.lastname: Olsen
authors.forename: Keith M
authors.initials: KM
authors.lastname: Swetz
authors.forename: Paul S
authors.initials: PS
authors.lastname: Mueller
mesh_terms: D016292:Procedural Sedation / Q000941:ethics / Q000379:methods*; D003657:Decision Making / Q000941:ethics*; D004992:Ethics, Medical; D006801:Humans; D010166:Palliative Care / Q000941:ethics / Q000379:methods*; D028761:Withholding Treatment / Q000941:ethics*
references.citation: Stetson Law Rev. 2005 Fall;35(1):195-205
references.pmid: 17100000
references.citation: J Pain Symptom Manage. 1996 Jul;12(1):32-8
references.pmid: 8718914
references.citation: Ann Oncol. 2009 Jul;20(7):1163-9
references.pmid: 19542532
references.citation: J Palliat Med. 2005 Jun;8(3):666-76
references.pmid: 15992211
references.citation: J Pain Symptom Manage. 2007 Sep;34(3):305-14
references.pmid: 17606359
references.citation: J Pain Symptom Manage. 2005 Oct;30(4):320-8
references.pmid: 16256896
references.citation: Am J Med. 2000 Dec 15;109(9):723-6
references.pmid: 11137488
references.citation: J Palliat Med. 2007 Feb;10(1):67-85
references.pmid: 17298256
references.citation: JAMA. 2000 Feb 23;283(8):1065-7
references.pmid: 10697071
references.citation: Oncologist. 2000;5(1):53-62
references.pmid: 10706650
references.citation: Ann Intern Med. 2002 Jun 4;136(11):845-9
references.pmid: 12044133
references.citation: Mayo Clin Proc. 2000 Oct;75(10):1064-9
references.pmid: 11040854
references.citation: N Engl J Med. 1997 Dec 11;337(24):1768-71
references.pmid: 9392707
references.citation: Ann Intern Med. 2000 Mar 7;132(5):408-14
references.pmid: 10691593
references.citation: J Med Ethics. 1995 Jun;21(3):135-40
references.pmid: 7674277
references.citation: J Pain Symptom Manage. 2008 Sep;36(3):310-33
references.pmid: 18657380
references.citation: J Palliat Care. 1994 Summer;10(2):31-8
references.pmid: 8089815
references.citation: J Med Ethics. 1996 Jun;22(3):147-53
references.pmid: 8798936
references.citation: J Pain Symptom Manage. 1991 Jul;6(5):329-36
references.pmid: 1856509
references.citation: N Engl J Med. 2005 Dec 15;353(24):2607-12
references.pmid: 16354899
references.citation: Palliat Med. 2009 Oct;23(7):581-93
references.pmid: 19858355
references.citation: J Pain Symptom Manage. 2005 Oct;30(4):308-19
references.pmid: 16256895
references.citation: N Engl J Med. 1997 Oct 23;337(17):1234-6
references.pmid: 9337388
references.citation: N Y Times Web. 2006 Jul 20;:A18
references.pmid: 16874935
references.citation: South Med J. 1991 Mar;84(3):332-7
references.pmid: 1705723
references.citation: J Pain Symptom Manage. 2008 Sep;36(3):228-34
references.pmid: 18411017
references.citation: Theor Med Bioeth. 2004;25(1):51-60
references.pmid: 15180095
references.citation: J Palliat Care. 2009 Spring;25(1):5-11
references.pmid: 19445337
references.citation: Palliat Support Care. 2006 Jun;4(2):135-43
references.pmid: 16903584
references.citation: Nat Clin Pract Oncol. 2006 Sep;3(9):492-500
references.pmid: 16955088