Palliative sedation is a measure of last resort used at the end of life to relieve severe and refractory symptoms. It is performed by the administration of sedative medications in monitored settings and is aimed at inducing a state of decreased awareness or absent awareness (unconsciousness).
Other studies report a survival time of < 3 weeks in 94% of people after starting palliative sedation. Some physicians estimate that this practice shortens life by ≤24 hours for 40% of people and > 1 week for 27% of people.
Sedation and agitation
The patient will commonly be started on a small dose of sedative (such as a benzodiazepine like midazolam or lorazepam). They may also be given an anti-psychotic (such as haloperidol). Medicines are usually given as injections or through a syringe pump (also known as a syringe driver).
Palliative sedation intends to relieve refractory symptoms in dying patients, whereas the intention of physician-assisted suicide and euthanasia is the termination of a patient's life.
Medications that are used to produce the sedation that relieves the distressing symptom(s) include sedating antipsychotics, intravenous benzodiazepines, and subcutaneous or intravenous barbiturates. A systematic review demonstrated no decrease in survival from the implementation of palliative sedation.
In most cases with CPST, sedation continues until death. In rare cases, however, patients may be woken up at some point, according to Downar.
Sometimes that means a light unconsciousness, in which the patient may still be somewhat aware of the presence of others. On other occasions it might mean a deep unconsciousness, not unlike a coma. In some cases, the palliative sedation is limited; in others it continues until death.
So, according to Orentlicher, terminal sedation that includes the withdraw of life sustaining treatment constitutes a form of (active) euthanasia that cannot be justified in terms of the doctrine of double effect.
Palliative sedation is the continuous administration of medication to relieve severe, intractable symptoms. Palliative sedation induces a coma-like state when symptoms such as pain, nausea, breathlessness, or delirium cannot be controlled while a patient is conscious. This state is maintained until death occurs.
Palliative sedation is used when traditional opioid-based therapies are either inadequate to control suffering or cause unacceptable adverse effects. Often, PS is used to treat delirium, pain, dyspnea, nausea, or other physical symptoms.
Palliative sedation may be utilized in both adults and children [2-6] with advanced incurable (ie, terminal) illness in order to alleviate severe symptoms that are refractory to other forms of treatment. It is most commonly utilized for the treatment of refractory pain, dyspnea, agitated delirium, and convulsions.
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.
The sedation can also be reversed, so the person is not completely asleep during the dying process. Research has shown that palliative sedation does not shorten life. People die from their disease – not from sedatives.
What is palliative care? If you have an illness that cannot be cured, palliative care makes you as comfortable as possible by managing your pain and other distressing symptoms. It also involves psychological, social and spiritual support for you and your family or carers.
Stage 3: Deteriorating
In this third stage, symptoms begin to worsen and overall health starts to decline. It's also around this time that more severe/complex medical issues can occur, meaning more readjustments to your care plan. Emotional and mental health support is vital in this stage.
Patients will be considered to be in the terminal stage of stroke or coma (life expectancy of six months or less) if they meet the following criteria.
The important findings, along with observations of long-time palliative care doctors and nurses, show: Brain activity supports that a dying patient most likely can hear. Even if awareness of sound cannot be communicated due to loss of motor responses, the value of verbal interactions is measurable and positive.
If a person is sedated with palliative sedation, they die from their illness. When a person is given MAiD, they die from the medication. The exact timing of death within days and hours is not known with palliative sedation, but is more predictable with MAiD.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
Metabolic failure: The kidneys, the liver, and other organs begin to fail near the end of life, and the physiological issues these events cause can interfere with brain function and result in delirium, restlessness, and agitation.
Without sedation, pet euthanasia can be a very abrupt and confronting process. The final injection is fast acting. With sedation the transition from a conscious pet to passing is a gradual one. Using sedation means the process of saying good bye is much smoother, and peaceful.
Midazolam is a commonly used benzodiazepine in palliative care and is considered one of the four essential drugs needed for the promotion of quality care in dying patients. Acting on the benzodiazepine receptor, it promotes the action of gamma-aminobutyric acid.
Deep Sedation: IV
Extremely relaxed. Comfortable during any procedure, even if you have sensitive teeth or gums. Virtually feel no pain.
Palliative sedation (PS), the medical act of decreasing a patient's awareness to relieve otherwise intractable suffering, is considered by some commentators to be controversial because of its consequences on residual survival and/or quality of life, and to be inappropriate for treating pure existential suffering.
With minimal and moderate sedation, you feel comfortable, sleepy and relaxed. You may drift off to sleep at times, but will be easy to wake. With general anaesthesia, you are completely unaware and unconscious during the procedure. Deep sedation is between the two.