title: Walking the line. Palliative sedation for existential distress: still a controversial issue?
abstract: Adequate symptom relief is a central aspect of medical care of all patients especially in those with an incurable disease. However, as an illness progresses and the end of life approaches, physical or psychoexistential symptoms may remain uncontrollable requiring palliative sedation. Although palliative sedation has become an increasingly implemented practice in the care of terminally ill patients, sedation in the management of refractory psychological symptoms and existential distress is still a controversial issue and much debated. This case report presents a patient who received palliative sedation for the treatment of existential distress and discusses considerations that may arise from such a therapeutic approach.
authors.affiliation: Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. sophie.schur@meduniwien.ac.at.
authors.forename: Sophie
authors.initials: S
authors.lastname: Schur
authors.affiliation: Department of Palliative Medicine, University Hospital Bonn, 53127, Bonn, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
authors.affiliation: Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Eva K
authors.initials: EK
authors.lastname: Masel
authors.affiliation: Palliative Care Consult Team, Hospital Horn-Allentsteig, Spitalgasse 10, 3580, Horn, Austria.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Weixler
authors.affiliation: Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Herbert H
authors.initials: HH
authors.lastname: Watzke
mesh_terms: D000368:Aged; D001293:Attitude to Death; D002294:Carcinoma, Squamous Cell / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy / Q000523:psychology; D016292:Procedural Sedation / Q000523:psychology*; D017281:Cost of Illness; D018450:Disease Progression; D005086:Existentialism / Q000523:psychology*; D006801:Humans; D008297:Male; D008874:Midazolam; D009042:Motivation; D009062:Mouth Neoplasms / Q000523:psychology / Q000628:therapy; D010166:Palliative Care / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology
chemical_list: D008874:Midazolam
keywords: Existential distress; Medical oncology; Palliative sedation