title: Level of consciousness in dying patients. The role of palliative sedation: a longitudinal prospective study.
abstract: BACKGROUND
  Patients suffering from a terminal illness often are confronted with severe symptoms during the last phase of their lives. Palliative sedation, although one of the options of last resort, remains a much debated and controversial issue and is often referred to as a form of slow euthanasia or euthanasia in disguise.
  
  
  METHODS
  A prospective longitudinal and descriptive design was used. Each patient admitted in one of the 8 participating units was included if they met the inclusion criteria and gave written informed consent.
  
  
  RESULTS
  266 patients were included. The incidence of palliative sedation was 7;5%. For the group of sedated patients results show that 90% entered the palliative care unit being fully conscious. Two patients were comatose upon arrival. 90% of the patients remained fully conscious up to the day palliative sedation was started. When looking at the effect of palliative sedation on the level of consciousness the analysis strongly suggest that the palliative sedation - as expected- has an impact on the GCS score. Irrespective of the dichotomization of the score the probability of having a lower GCS increases substantially once sedation is initiated. Additionally, results show that once palliative sedation is administered, the level of consciousness gradually goes down up until the day of death.
  
  
  CONCLUSIONS
  Palliative sedation is nor slow euthanasia nor an ambivalent practice. It is an intentional medical treatment which is administered in a proportional way when refractory suffering occurs. It occurs in extraordinary situations and at the very end of the dying process.
authors: Centre for Biomedical Ethics and Law, Catholic University Leuven, Drongen, Belgium. patricia.claessens@arteveldehs.be
authors: Patricia
authors: P
authors: Claessens
authors: Johan
authors: J
authors: Menten
authors: Paul
authors: P
authors: Schotsmans
authors: Bert
authors: B
authors: Broeckaert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003243:Consciousness / Q000145:classification / Q000187:drug effects*; D005065:Euthanasia; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007258:Informed Consent; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D010166:Palliative Care / Q000379:methods*; D019452:Terminally Ill
chemical_list: D006993:Hypnotics and Sedatives