NDLI: Palliative Sedation in Dying Patients: “We Turn to It When Everything Else Hasn’t Worked”

Content Provider	JAMA Network
Author	Lo, Bernard Rubenfeld, Gordon
Copyright Year	2005
Abstract	Despite skilled palliative care, some dying patients experience distressing symptoms that cannot be adequately relieved. A patient with metastatic breast cancer, receiving high doses of opioids administered to relieve pain, developed myoclonus. After other approaches proved ineffective, palliative sedation was an option of last resort. The doctrine of double effect, the traditional justification for palliative sedation, permits physicians to provide high doses of opioids and sedatives to relieve suffering, provided that the intention is not to cause the patient’s death and that certain other conditions are met. Such high doses are permissible even if the risk of hastening death is foreseen. Because intention plays a key role in this doctrine, clinicians must understand and document which actions are consistent with an intention to relieve symptoms rather than to hasten death. The patient or family should agree with plans for palliative sedation. The attending physician needs to explain to them, as well as to the medical and nursing staff, the details of care and the justification for palliative sedation. Because cases involving palliative sedation are emotionally stressful, the patient, family, and health care workers can all benefit from talking about the complex medical, ethical, and emotional issues they raise.
Ending Page	1816
Starting Page	1810
Page Count	7
File Format	PDF HTM / HTML
ISSN	00987484
DOI	10.1001/jama.294.14.1810
Issue Number	14
Journal	JAMA
Volume Number	294
Language	English
Publisher	American Medical Association
Publisher Date	2005-10-12
Access Restriction	Subscribed
Subject Keyword	terminally ill palliative sedation pain palliative care opioids sedative myoclonus
Content Type	Text
Resource Type	Article
Subject	Medicine

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