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

Disclosures

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

In This Article

Nursing Positions on Palliative Sedation

Two nursing organizations have explicitly stated their positions on the use of palliative sedation in EOL care. Both organizations emphasize that palliative sedation should be reserved for those whose suffering is refractory and not controlled by other appropriate palliative care measures. The intent of palliative sedation is aimed at minimizing suffering and not hastening death.

The American Nurses Association[19] (ANA) position paper on pain management and control of distressing symptoms in dying patients provides that when restoration of health is no longer possible, the focus of nursing care is assuring a comfortable, dignified death and the highest possible quality of remaining life. One of the major fears of patients and their families as they approach death is intractable pain. The assessment and management of pain and other distressing symptoms must be based on an informed understanding of the individual patient's values and goals and his or her emotional, physical, and spiritual needs, and on an understanding of the pathophysiology of the disease state and evidence-based palliative care practice.[20] When pain and other distressing symptoms are present, the patient should have appropriate and sufficient medication by appropriate routes to control symptoms in whatever dosage and by whatever route is needed to control symptoms as perceived by the patient.[21] The ANA's Code of Ethics for Nurses[22] also states that nurses may not act with the sole intent to end a patient's life even if motivated by compassion and concern for dignity and quality of life.

The Hospice and Palliative Nurses Association (HPNA) is committed to compassionate care of persons at the end of life.[14] The HPNA position statement on palliative sedation at end of life affirms the use of palliative sedation to manage refractory and unendurable symptoms in imminently dying patients as one method of aggressive and comprehensive symptom management.

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