Palliative Sedation: When Suffering Is Intractable at End of Life

Peg Nelson Bander, MSN, NP, ACHPN, FPCN

Disclosures

Journal of Hospice and Palliative Nursing. 2017;19(5):394-401. 

In This Article

Abstract and Introduction

Abstract

Palliative sedation at the end of life is a necessary option for patients who have intractable symptoms and are suffering when other palliative interventions have been ineffective. Although recognized in palliative care as an ethically sound and legally sanctioned practice, some nurses continue to express concern that death is being hastened. The intent of this article is to provide clarity to the practice of palliative sedation at end of life.

Introduction

Although most patients at end of life exhibit suffering that can be controlled to a tolerable level, there are situations when physical and/or psychological distress, even with expert palliative care, precludes any hope for a peaceful death. Palliative sedation is a treatment that may be offered as a last resort to dying patients, when all other treatments of suffering have failed. Review of palliative sedation literature and practice indicates a lack of consensus of practice methods, definitions, and significant expressions of ethical concern and conflict by practitioners on the moral appropriateness of its use. The key ethical concern being as follows: Is palliative sedation actually euthanasia and does it hasten death? This article will present a case that demonstrates the use of palliative sedation and one nurse's conflicts with participating with the practice. A review of the current and seminal literature regarding the practice of palliative sedation, including the ethical principles that guide its use, will be discussed. Moreover, suggested guidelines for nurses and healthcare teams to follow when considering and implementing palliative sedation will be provided.

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