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Palliative Sedation When and How Its Used

Palliative Care

Updated 06-01-2024

Palliative Sedation When and How Its Used

Palliative sedation stands as a compassionate approach in medical care, designed to alleviate intractable and unmanageable symptoms when a patient's life nears its end. This practice is employed with the utmost ethical consideration and aims to maintain the dignity of patients during their final moments, when other forms of symptom control have proven ineffective.

Understanding Palliative Sedation

Palliative sedation, often misunderstood, is an intentionally lowered state of consciousness induced to relieve unbearable suffering which hasn't responded to all other conventional treatments. It's imperative to realise this is not an act to hasten death, but rather a means to address severe symptom distress, enhancing the quality of life in the patient’s remaining time.

Indications for the Use of Palliative Sedation

The administration of palliative sedation may be considered under specific circumstances. Medical professionals look for the evidence of refractory symptoms, which could include:

  • Severe pain
  • Dyspnoea (breathlessness)
  • Terminal agitation
  • Nausea and vomiting that cannot be controlled with standard treatment

It is only contemplated when these symptoms are causing profound suffering and standard palliative interventions have not brought the needed relief.

The Ethical Framework

Palliative sedation demands a robust ethical framework. Consent is a pivotal aspect of this, and it includes comprehensive discussions with the patient (when possible), and their family or caregivers about the goals, risks, and the expected outcome of sedation.

A shared decision-making model is ideal, ensuring that the patient’s values, beliefs, and wishes are respected. When a patient is unable to consent due to decreased consciousness or cognitive impairment, substitute decision-makers, usually close family members, are engaged in the consent process.

Continuous Versus Intermittent Sedation

The method of sedation can vary depending on the individual case. Continuous deep sedation may be considered in scenarios where symptoms are relentless and severe. Intermittent sedation may be preferable when symptoms are episodic or when it's impractical to maintain continuous sedation.

The Medications and Methods

The medications used for palliative sedation are typically central nervous system depressants like benzodiazepines (e.g., midazolam), barbiturates (e.g., phenobarbital), or propofol. The choice of medication is carefully considered based on factors like patient history, symptomatology, and the side-effect profile.

Administration Protocols

A gradual titration method is generally utilised, starting with the lowest possible dose and carefully adjusting upwards to achieve the desired level of sedation while monitoring the patient closely. This cautious approach ensures that sedation is not deeper than necessary to control symptoms.

The Role of Health Care Providers

Health care providers, including doctors, nurses, and allied health professionals, play a critical role in palliative sedation. Their responsibilities include:

  • Assessing the appropriateness of palliative sedation for each individual patient
  • Ensuring clear communication amongst the care team, the patient, and the family
  • Providing emotional support to the patient and loved ones
  • Managing the sedation process to optimise patient comfort without hastening death

Special Considerations in the Australian Context

In the Australian healthcare setting, the principles of palliative sedation align with the values of patient-centred care and the national palliative care standards. Medical professionals must adhere to state and federal regulations along with the ethical standards established by medical boards and councils.

Conclusion: Palliative Sedation as Part of Holistic End-of-Life Care

Palliative sedation remains a valuable component in the spectrum of end-of-life care, entrusted to the discretion and wisdom of palliative care teams. It's a testament to the commitment of providing relief and comfort, allowing patients to live their final days with grace and dignity, without the shadow of unbearable suffering. The decision to proceed with palliative sedation is multifaceted and profound, always taken with the intent of mercy, grounded on a bedrock of clinical expertise, ethical practice, and compassionate understanding.

About the Author

Olivia is a seasoned professional with an extensive career spanning the Aged Care sector, bringing decades of experience to her role. Her comprehensive understanding of Aged Care services and practices is a testament to her dedication. Olivia’s gratitude extends to those who have generously shared their knowledge and insights with her over the years, contributing to her wealth of expertise.
Olivia’s articles reflect her commitment to practical and informative content. They skillfully combine her industry know-how with real-world insights, providing valuable resources for navigating the complexities of the Aged Care sector. Olivia stands as a reliable advocate for delivering compassionate and effective care to elderly individuals, offering her support not only to fellow caregivers and professionals but also to those seeking to gain a deeper understanding of the sector.

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