Palliative Sedation Therapy Research Paper
Erica Lottes
Professor Mary Pat Henehan, MPH, MA, DMin, RN, LMFT
Washington University in Saint Louis, George Warren Brown School
Palliative Sedation Therapy
Introduction Palliative care endeavors to relieve pain and offer comfort for people in the final stage of their life. In the final days, some patients may suffer from refractory symptoms. A widely accepted definition of refractory symptom is ‘symptom for which all possible treatment has failed, or it is estimated that no methods are available for palliation within the time frame and the risk-benefit ration that the patient can tolerate,’ (Maltoni et al., 2009). For patients who experience refractory symptoms a legal treatment option is palliative sedation. Palliative sedation …show more content…
Psychological and existential distress as symptoms involving the need for palliative sedation is very controversial. The research and literature on palliative sedation therapy is not extensive. In the early to mid-2000s, researchers all over the world began publishing more systematic research on the use of sedation (de Graeff & Dean, 2007). Systematic research found there are limited amount of guidelines for clinical practice and prevalence of patients requiring sedation varied widely among studies-due to different definitions and cultural beliefs. Although the medical field does not have any formal recommendations or guidelines from nationally esteemed organizations, patients have been increasingly requesting the medical intervention. In the years 2000–2002, there was an increase in the request for sedation in the final days of life from 19% to 34% by the patients themselves, documented in personal statements or advance directives (Muller-Busch, Andres & Jehser, 2003). Requests for sedation are increasingly more common, but the ethical implications may rise to conflicts between patients ' wishes to hasten death and physicians ' intentions to provide the best care and not to shorten life. This …show more content…
People on both sides of the argument recognize additional factors may influence the determination of refractory symptoms and if the case calls for PST. For example, several studies indicate wide varying practices of PST among physicians based on personal factors-philosophy about a good death, beliefs about the effect of PST on survival, medical practice, experience, religious practice and fatigue and levels of burnout can result in increased use of PST (de Graeff & Dean, 2007). Studies from other countries indicate that administration of sedating medication with the clear intent of hastening death is commonplace (Chiu, Hu, Lue, Cheng & Chen, 2001). This is described as a ‘slow euthanasia,’ and is morally equivalent to euthanasia which is maleficent and undercuts the medical profession’s integrity. Since the use of PST is open to much abuse, it becomes a slippery slope and physicians will begin killing other
Professor Mary Pat Henehan, MPH, MA, DMin, RN, LMFT
Washington University in Saint Louis, George Warren Brown School
Palliative Sedation Therapy
Introduction Palliative care endeavors to relieve pain and offer comfort for people in the final stage of their life. In the final days, some patients may suffer from refractory symptoms. A widely accepted definition of refractory symptom is ‘symptom for which all possible treatment has failed, or it is estimated that no methods are available for palliation within the time frame and the risk-benefit ration that the patient can tolerate,’ (Maltoni et al., 2009). For patients who experience refractory symptoms a legal treatment option is palliative sedation. Palliative sedation …show more content…
Psychological and existential distress as symptoms involving the need for palliative sedation is very controversial. The research and literature on palliative sedation therapy is not extensive. In the early to mid-2000s, researchers all over the world began publishing more systematic research on the use of sedation (de Graeff & Dean, 2007). Systematic research found there are limited amount of guidelines for clinical practice and prevalence of patients requiring sedation varied widely among studies-due to different definitions and cultural beliefs. Although the medical field does not have any formal recommendations or guidelines from nationally esteemed organizations, patients have been increasingly requesting the medical intervention. In the years 2000–2002, there was an increase in the request for sedation in the final days of life from 19% to 34% by the patients themselves, documented in personal statements or advance directives (Muller-Busch, Andres & Jehser, 2003). Requests for sedation are increasingly more common, but the ethical implications may rise to conflicts between patients ' wishes to hasten death and physicians ' intentions to provide the best care and not to shorten life. This …show more content…
People on both sides of the argument recognize additional factors may influence the determination of refractory symptoms and if the case calls for PST. For example, several studies indicate wide varying practices of PST among physicians based on personal factors-philosophy about a good death, beliefs about the effect of PST on survival, medical practice, experience, religious practice and fatigue and levels of burnout can result in increased use of PST (de Graeff & Dean, 2007). Studies from other countries indicate that administration of sedating medication with the clear intent of hastening death is commonplace (Chiu, Hu, Lue, Cheng & Chen, 2001). This is described as a ‘slow euthanasia,’ and is morally equivalent to euthanasia which is maleficent and undercuts the medical profession’s integrity. Since the use of PST is open to much abuse, it becomes a slippery slope and physicians will begin killing other