Skip to main content
Erschienen in: Wiener Medizinische Wochenschrift 23-24/2015

01.12.2015 | main topic

Walking the line. Palliative sedation for existential distress: still a controversial issue?

verfasst von: Sophie Schur, Lukas Radbruch, Eva K. Masel, Dietmar Weixler, Herbert H. Watzke

Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 23-24/2015

Einloggen, um Zugang zu erhalten

Abstract

Adequate symptom relief is a central aspect of medical care of all patients especially in those with an incurable disease. However, as an illness progresses and the end of life approaches, physical or psychoexistential symptoms may remain uncontrollable requiring palliative sedation. Although palliative sedation has become an increasingly implemented practice in the care of terminally ill patients, sedation in the management of refractory psychological symptoms and existential distress is still a controversial issue and much debated. This case report presents a patient who received palliative sedation for the treatment of existential distress and discusses considerations that may arise from such a therapeutic approach.
Literatur
1.
Zurück zum Zitat Cherny NI, E.G.W. Group. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol. 2014;25(Suppl 3):iii143–52.CrossRefPubMed Cherny NI, E.G.W. Group. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol. 2014;25(Suppl 3):iii143–52.CrossRefPubMed
2.
Zurück zum Zitat Barbera L, et al. Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer. 2010;116(24):5767–76.CrossRefPubMed Barbera L, et al. Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer. 2010;116(24):5767–76.CrossRefPubMed
3.
Zurück zum Zitat Kutner JS, et al. Time course and characteristics of symptom distress and quality of life at the end of life. J Pain Symptom Manage. 2007;34(3):227–36.CrossRefPubMed Kutner JS, et al. Time course and characteristics of symptom distress and quality of life at the end of life. J Pain Symptom Manage. 2007;34(3):227–36.CrossRefPubMed
4.
Zurück zum Zitat Cherny NI, Radbruch L, Board of the European Association for Palliative Care. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med. 2009;23(7):581–93.CrossRefPubMed Cherny NI, Radbruch L, Board of the European Association for Palliative Care. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med. 2009;23(7):581–93.CrossRefPubMed
5.
Zurück zum Zitat Lo B, Rubenfeld G. Palliative sedation in dying patients: “we turn to it when everything else hasn’t worked”. JAMA. 2005;294(14):1810–6.CrossRefPubMed Lo B, Rubenfeld G. Palliative sedation in dying patients: “we turn to it when everything else hasn’t worked”. JAMA. 2005;294(14):1810–6.CrossRefPubMed
6.
Zurück zum Zitat Cherny NI, Portenoy RK. Sedation in the management of refractory symptoms: guidelines for evaluation and treatment. J Palliat Care. 1994;10(2):31–8.PubMed Cherny NI, Portenoy RK. Sedation in the management of refractory symptoms: guidelines for evaluation and treatment. J Palliat Care. 1994;10(2):31–8.PubMed
7.
Zurück zum Zitat Schildmann E, Schildmann J. Palliative sedation therapy: a systematic literature review and critical appraisal of available guidance on indication and decision making. J Palliat Med. 2014;17(5):601–11.CrossRefPubMed Schildmann E, Schildmann J. Palliative sedation therapy: a systematic literature review and critical appraisal of available guidance on indication and decision making. J Palliat Med. 2014;17(5):601–11.CrossRefPubMed
8.
Zurück zum Zitat Morita T, et al. Terminal sedation for existential distress. Am J Hosp Palliat Care. 2000;17(3):189–95.CrossRefPubMed Morita T, et al. Terminal sedation for existential distress. Am J Hosp Palliat Care. 2000;17(3):189–95.CrossRefPubMed
9.
Zurück zum Zitat Schildmann J, Schildmann E. Clinical and ethical challenges of palliative sedation therapy. The need for clear guidance and professional competencies. Int J Clin Pract. 2013;67(11):1086–8.CrossRefPubMed Schildmann J, Schildmann E. Clinical and ethical challenges of palliative sedation therapy. The need for clear guidance and professional competencies. Int J Clin Pract. 2013;67(11):1086–8.CrossRefPubMed
10.
11.
Zurück zum Zitat Maltoni M, et al. Palliative sedation in end-of-life care and survival: a systematic review. J Clin Oncol. 2012;30(12):1378–83.CrossRefPubMed Maltoni M, et al. Palliative sedation in end-of-life care and survival: a systematic review. J Clin Oncol. 2012;30(12):1378–83.CrossRefPubMed
12.
Zurück zum Zitat de Graeff A, Dean M. Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med. 2007;10(1):67–85.CrossRefPubMed de Graeff A, Dean M. Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med. 2007;10(1):67–85.CrossRefPubMed
13.
Zurück zum Zitat Dean MM, et al. Framework for continuous palliative sedation therapy in Canada. J Palliat Med. 2012;15(8):870–9.CrossRefPubMed Dean MM, et al. Framework for continuous palliative sedation therapy in Canada. J Palliat Med. 2012;15(8):870–9.CrossRefPubMed
14.
Zurück zum Zitat Kirk TW, et al. National Hospice and Palliative Care Organization (NHPCO) position statement and commentary on the use of palliative sedation in imminently dying terminally ill patients. J Pain Symptom Manage. 2010;39(5):914–23.CrossRefPubMed Kirk TW, et al. National Hospice and Palliative Care Organization (NHPCO) position statement and commentary on the use of palliative sedation in imminently dying terminally ill patients. J Pain Symptom Manage. 2010;39(5):914–23.CrossRefPubMed
15.
Zurück zum Zitat Legemaate J, et al. Palliative sedation in the Netherlands: starting-points and contents of a national guideline. Eur J Health Law. 2007;14(1):61–73.CrossRefPubMed Legemaate J, et al. Palliative sedation in the Netherlands: starting-points and contents of a national guideline. Eur J Health Law. 2007;14(1):61–73.CrossRefPubMed
16.
Zurück zum Zitat Morita T. Differences in physician-reported practice in palliative sedation therapy. Support Care Cancer. 2004;12(8):584–92.CrossRefPubMed Morita T. Differences in physician-reported practice in palliative sedation therapy. Support Care Cancer. 2004;12(8):584–92.CrossRefPubMed
17.
Zurück zum Zitat Schuman ZD, Abrahm JL. Implementing institutional change: an institutional case study of palliative sedation. J Palliat Med. 2005;8(3):666–76.CrossRefPubMed Schuman ZD, Abrahm JL. Implementing institutional change: an institutional case study of palliative sedation. J Palliat Med. 2005;8(3):666–76.CrossRefPubMed
18.
Zurück zum Zitat Rietjens JA, et al. Physician reports of terminal sedation without hydration or nutrition for patients nearing death in the Netherlands. Ann Intern Med. 2004;141(3):178–85.CrossRefPubMed Rietjens JA, et al. Physician reports of terminal sedation without hydration or nutrition for patients nearing death in the Netherlands. Ann Intern Med. 2004;141(3):178–85.CrossRefPubMed
19.
Zurück zum Zitat Teunissen SC, et al. Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage. 2007;34(1):94–104.CrossRefPubMed Teunissen SC, et al. Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage. 2007;34(1):94–104.CrossRefPubMed
20.
Zurück zum Zitat Fainsinger R, et al. Symptom control during the last week of life on a palliative care unit. J Palliat Care. 1991;7(1):5–11. Fainsinger R, et al. Symptom control during the last week of life on a palliative care unit. J Palliat Care. 1991;7(1):5–11.
21.
Zurück zum Zitat Fainsinger RL, et al. Sedation for uncontrolled symptoms in a South African hospice. J Pain Symptom Manage. 1998;16(3):145–52.CrossRefPubMed Fainsinger RL, et al. Sedation for uncontrolled symptoms in a South African hospice. J Pain Symptom Manage. 1998;16(3):145–52.CrossRefPubMed
22.
Zurück zum Zitat Morita T, Inoue S, Chihara S. Sedation for symptom control in Japan: the importance of intermittent use and communication with family members. J Pain Symptom Manage. 1996;12(1):32–8.CrossRefPubMed Morita T, Inoue S, Chihara S. Sedation for symptom control in Japan: the importance of intermittent use and communication with family members. J Pain Symptom Manage. 1996;12(1):32–8.CrossRefPubMed
23.
Zurück zum Zitat Stone P, et al. A comparison of the use of sedatives in a hospital support team and in a hospice. Palliat Med. 1997;11(2):140–4.CrossRefPubMed Stone P, et al. A comparison of the use of sedatives in a hospital support team and in a hospice. Palliat Med. 1997;11(2):140–4.CrossRefPubMed
24.
Zurück zum Zitat Ventafridda V, et al. Symptom prevalence and control during cancer patients’ last days of life. J Palliat Care. 1990;6(3):7–11.PubMed Ventafridda V, et al. Symptom prevalence and control during cancer patients’ last days of life. J Palliat Care. 1990;6(3):7–11.PubMed
25.
Zurück zum Zitat Rietjens JA, et al. Palliative sedation in a specialized unit for acute palliative care in a cancer hospital: comparing patients dying with and without palliative sedation. J Pain Symptom Manage. 2008;36(3):228–34.CrossRefPubMed Rietjens JA, et al. Palliative sedation in a specialized unit for acute palliative care in a cancer hospital: comparing patients dying with and without palliative sedation. J Pain Symptom Manage. 2008;36(3):228–34.CrossRefPubMed
26.
27.
Zurück zum Zitat Radbruch L, Krumm N, Elsner F. Can palliative sedation be a solution when a patient requests active euthanasia? Eur J Palliat Care. 2008;15(6):266–7. Radbruch L, Krumm N, Elsner F. Can palliative sedation be a solution when a patient requests active euthanasia? Eur J Palliat Care. 2008;15(6):266–7.
28.
Zurück zum Zitat Radbruch L. Reflections on the use of sedation in terminal care. Eur J Palliat Care. 2002;9(6):237–9. Radbruch L. Reflections on the use of sedation in terminal care. Eur J Palliat Care. 2002;9(6):237–9.
29.
Zurück zum Zitat Luckett T, et al. Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature. Support Care Cancer. 2011;19(7):871–81.CrossRefPubMed Luckett T, et al. Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature. Support Care Cancer. 2011;19(7):871–81.CrossRefPubMed
30.
Zurück zum Zitat Penner JL. Psychosocial care of patients with head and neck cancer. Semin Oncol Nurs. 2009;25(3):231–41.CrossRefPubMed Penner JL. Psychosocial care of patients with head and neck cancer. Semin Oncol Nurs. 2009;25(3):231–41.CrossRefPubMed
Metadaten
Titel
Walking the line. Palliative sedation for existential distress: still a controversial issue?
verfasst von
Sophie Schur
Lukas Radbruch
Eva K. Masel
Dietmar Weixler
Herbert H. Watzke
Publikationsdatum
01.12.2015
Verlag
Springer Vienna
Erschienen in
Wiener Medizinische Wochenschrift / Ausgabe 23-24/2015
Print ISSN: 0043-5341
Elektronische ISSN: 1563-258X
DOI
https://doi.org/10.1007/s10354-015-0402-5

Weitere Artikel der Ausgabe 23-24/2015

Wiener Medizinische Wochenschrift 23-24/2015 Zur Ausgabe