Palliative Sedation in End-of-Life Care

Susan D. Bruce, RN, BSN, OCN; Cristina C. Hendrix, DNS, APRN-BC, GNP, FNP; Jennifer H. Gentry, RN, MSN, ANP, APRN-BC, PCM


Journal of Hospice and Palliative Nursing. 2006;8(6):320-327. 

In This Article

Abstract and Introduction

The goals for care at the end of life include relief of pain and suffering. Despite excellent palliative care, some patients continue to experience intolerable, unrelieved pain and suffering from refractory symptoms. Palliative sedation, although controversial, is an accepted option for relieving pain and suffering at the end of life and can spark a great deal of emotion and debate for all involved. Hospice and palliative care nurses play a critical role in symptom management at the end of life and need to have a basic understanding of the principles of palliative sedation. Nurses must continue to advocate for their patients and provide education to other members of the healthcare team who are less knowledgeable about palliative sedation. This article explores these principles and some of the challenges associated with providing palliative sedation.

Adequate control of symptoms should be the standard of care for dying patients. An important goal to reach is the relief of pain and suffering;[1] however, some patients develop intolerable pain and suffering despite excellent palliative care. In such patients, sedation has been used to treat pain, dyspnea, nausea and vomiting, delirium, and myoclonus in order to allow patients to die comfortably.[2] When given with the sole intent of relieving pain and suffering at the end of life, sedation has become an accepted but highly controversial aspect of palliative care. The healthcare team and the family of the dying patient may face many moral, ethical, and legally challenging decisions throughout the dying process, which can elicit a great deal of emotion and debate. This article provides discussion about palliative sedation and its use in end-of-life (EOL) care. The ethical, legal, and moral issues that challenge healthcare professionals in using this modality of supportive care are highlighted. The article concludes with a discussion on the process of palliative sedation and nurses' roles.


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