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Continuous sedation until death

Tatsuya Morita, Kengo Imai, Naosuke Yokomichi, Masanori Mori, Yoshiyuki Kizawa, Satoru Tsuneto
Continuous deep sedation until death (CDS) is a type of palliative sedation therapy, and it has recently become a focus of intense debate. Marked inconsistencies in intervention procedures (i.e., what is CDS?) and unstandardized descriptions of patient backgrounds lead to difficulty in comparing the results in the literature. The primary aim of this paper was to propose a conceptual framework to perform empirical studies on CDS. We propose the definition of CDS using the intervention protocol. As there are two types of CDS proposed in world-wide literature, we recommend to prepare two types of intervention protocol for CDS: "continuous deep sedation as a result of proportional sedation" (gradual CDS), and "continuous deep sedation to rapidly induce unconsciousness" (rapid CDS)...
October 13, 2016: Journal of Pain and Symptom Management
Blair Henry
PURPOSE OF REVIEW: Palliative sedation has been the subject of intensive debate since its first appearance in 1990. In a 2010 review of palliative sedation, the following areas were identified as lacking in consensus: inconsistent terminology, its use in nonphysical suffering, the ongoing experience of distress, and concern that the practice of palliative sedation may hasten death. This review looks at the literature over the past 6 years and provides an update on these outstanding concerns...
September 2016: Current Opinion in Supportive and Palliative Care
Lenzo Robijn, Joachim Cohen, Judith Rietjens, Luc Deliens, Kenneth Chambaere
BACKGROUND: Continuous deep sedation until death is a highly debated medical practice, particularly regarding its potential to hasten death and its proper use in end-of-life care. A thorough analysis of important trends in this practice is needed to identify potentially problematic developments. This study aims to examine trends in the prevalence and practice characteristics of continuous deep sedation until death in Flanders, Belgium between 2007 and 2013, and to study variation on physicians' degree of palliative training...
2016: PloS One
Robert Zittoun
Continuous sedation until death (CSUD) is a practice which has developed recently in several countries, appearing more acceptable than euthanasia and medically assisted suicide, since more close to a "natural death". The French parliament has just adopted a law which stipulates CSUD on request of the patient in a definite number of circumstances, especially in incurable diseases near to the terminal stage with suffering refractory to treatments. Thus France has adopted a unique international position for the end-of-life care...
July 2016: La Presse Médicale
Tze Ling Gwendoline Beatrice Soh, Lalit Kumar Radha Krishna, Shin Wei Sim, Alethea Chung Peng Yee
Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it...
May 2016: Singapore Medical Journal
Sophie Schur, Dietmar Weixler, Christoph Gabl, Gudrun Kreye, Rudolf Likar, Eva Katharina Masel, Michael Mayrhofer, Franz Reiner, Barbara Schmidmayr, Kathrin Kirchheiner, Herbert Hans Watzke
BACKGROUND: Sedation is used to an increasing extent in end-of-life care. Definitions and indications in this field are based on expert opinions and case series. Little is known about this practice at palliative care units in Austria. METHODS: Patients who died in Austrian palliative care units between June 2012 and June 2013 were identified. A predefined set of baseline characteristics and information on sedation during the last two weeks before death were obtained by reviewing the patients' charts...
2016: BMC Palliative Care
Bernard Devalois, Louis Puybasset
New French 2016' Act recognizes 3 new rights for patients at the end of their life: right to dead without futilities, right to have their wishes respected and right to be comfortable in all circumstances. Medical acts must not be continued in an unreasonable way. Futility is defined by useless, disproportionate or without another aim that an artificial life sustaining acts. For patients who cannot tell their wishes, a withdrawing or withholding decision of life sustaining treatments can be taken with a collegiate process...
April 2016: La Presse Médicale
Govert den Hartogh
When a severely suffering dying patient is deeply sedated, and this sedated condition is meant to continue until his death, the doctor involved often decides to abstain from artificially administering fluids. For this dual procedure almost all guidelines require that the patient should not have a life expectancy beyond a stipulated maximum of days (4-14). The reason obviously is that in case of a longer life-expectancy the patient may die from dehydration rather than from his lethal illness. But no guideline tells us how we should describe the dual procedure in case of a longer life-expectancy...
June 2016: Medicine, Health Care, and Philosophy
L Robijn, K Chambaere, K Raus, J Rietjens, L Deliens
End-of-life sedation, though increasingly prevalent and widespread, remains a highly debated medical practice in the context of palliative medicine. This qualitative study aims to look more specifically at how health care workers justify their use of continuous sedation until death and which factors they report as playing a part in the decision-making process. In-depth interviews were held with 28 physicians and 22 nurses of 27 cancer patients in Belgium who had received continuous sedation until death in hospitals, palliative care units or at home...
October 29, 2015: European Journal of Cancer Care
Samuel H LiPuma, Joseph P DeMarco
Susan D. McCammon and Nicole M. Piemonte offer a thoughtful and thorough commentary on our manuscript entitled "Expanding the use of Continuous Sedation Until Death." In this reply we attempt to clarify and further defend our position. We show how continuous sedation until death is not a "first resort" but rather a legitimate option among many that should available to terminally ill patients whose life expectancy is less than six months. We also attempt to show that we do not equivocate the meaning of palliative care as the commentators suggested...
2015: Journal of Clinical Ethics
Joseph A Raho, Guido Miccinesi
Patients who are imminently dying sometimes experience symptoms refractory to traditional palliative interventions, and in rare cases, continuous sedation is offered. Samuel H. LiPuma, in a recent article in this Journal, argues that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia based on a higher brain neocortical definition of death. We contest his position that continuous sedation involves killing and offer four objections to the equivalency thesis. First, sedation practices are proportional in a way that physician-assisted suicide/euthanasia is not...
October 2015: Journal of Medicine and Philosophy
Mark J Cherry
This issue of The Journal of Medicine and Philosophy assesses the deep and abiding tensions that exist among the competing epistemic perspectives that bear on medicine and morality. Concepts of health and disease, as well as the theoretical framing of medical ethics and health care policy, intersect with an overlapping set of culturally situated communities (scientific, political, moral, and religious), striving to understand and manipulate the world in ways that each finds explanatory, appropriate, or otherwise befitting...
October 2015: Journal of Medicine and Philosophy
Susan D McCammon, Nicole M Piemonte
Samuel H. LiPuma and Joseph P. DeMarco argue for a positive right to continuous sedation until death (CSD) for any patient with a life expectancy less than six months. They reject any requirement of proportionality. Their proposed guideline makes CSD an option for a decisional adult patient with an appropriate terminal diagnosis regardless of whether suffering (physical or existential) is present. This guideline purports to "empower" the patient with the ability to control the timing and manner of her death...
2015: Journal of Clinical Ethics
Samuel H LiPuma, Joseph P DeMarco
As currently practiced, the use of continuous sedation until death (CSD) is controlled by clinicians in a way that may deny patients a key choice in controlling their dying process. Ethical guidelines from the American Medical Association and the American Academy of Pain Medicine describe CSD as a "last resort," and a position statement from the American Academy of Hospice and Palliative Medicine describe it as "an intervention reserved for extreme situations." Accordingly, patients must progress to unremitting pain and suffering and reach a last-resort stage before the option to pursue CSD is considered...
2015: Journal of Clinical Ethics
Ryan N Hansen, Denise M Boudreau, Beth E Ebel, David C Grossman, Sean D Sullivan
OBJECTIVES: We sought to estimate the association between sedative hypnotic use and motor vehicle crash risk. METHODS: We conducted a new user cohort study of 409 171 adults in an integrated health care system. Health plan data were linked to driver license and collision records. Participants were aged 21 years or older, licensed to drive in Washington State, had at least 1 year of continuous enrollment between 2003 and 2008, and were followed until death, disenrollment, or study end...
August 2015: American Journal of Public Health
Palle Toft, Hanne Tanghus Olsen, Helene Korvenius Jørgensen, Thomas Strøm, Helle Lykkeskov Nibro, Jacob Oxlund, Karl-Andre Wian, Lars Marius Ytrebø, Bjørn Anders Kroken, Michelle Chew
BACKGROUND: Through many years, the standard care has been to use continuous sedation of critically ill patients during mechanical ventilation. However, preliminary randomised clinical trials indicate that it is beneficial to reduce the sedation level. No randomised trial has been conducted comparing sedation with no sedation, a priori powered to have all-cause mortality as primary outcome.The objective is to assess the benefits and harms of non-sedation versus sedation with a daily wake-up trial in critically ill patients...
2014: Trials
You Fu, Xiuming Xi
OBJECTIVE: To investigate the prevalent condition of endotracheal cuff pressure and risk factors for under inflation. METHODS: A prospective cohort study was conducted. Patients admitted to the Department of Critical Care Medicine of Fuxing Hospital Affiliated to Capital Medical University, who were intubated with a high-volume low-pressure endotracheal tube, and had undergone mechanical ventilation for at least 48 hours, were enrolled. The endotracheal cuff pressure was determined every 8 hours by a manual manometer connected to the distal edge of the valve cuff at 07 : 00, 15 : 00, and 23 : 00...
December 2014: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Guido Wassink, Christopher A Lear, Katherine C Gunn, Justin M Dean, Laura Bennet, Alistair J Gunn
Multiple randomized controlled trials have shown that prolonged, moderate cerebral hypothermia initiated within a few hours after severe hypoxia-ischemia and continued until resolution of the acute phase of delayed cell death reduces mortality and improves neurodevelopmental outcome in term infants. The challenge is now to find ways to further improve outcomes. In the present review, we critically examine the evidence that conventional analgesic, sedative, or anticonvulsant agents might improve outcomes, in relation to the known window of opportunity for effective protection with hypothermia...
April 2015: Seminars in Fetal & Neonatal Medicine
Sam Rys, Freddy Mortier, Luc Deliens, Johan Bilsen
OBJECTIVES: To investigate how continuous sedation until death (CSD), the reduction or removal of consciousness of an incurably ill individual until death to relieve refractory suffering, is practiced in nursing homes. DESIGN: Nationwide cross-sectional retrospective survey. SETTING: Nursing homes in Flanders, Belgium. PARTICIPANTS: Palliative care nurses (N = 660) in all nursing homes in Flanders. MEASUREMENTS: Nurse reports of their most recent patient treated with CSD...
October 2014: Journal of the American Geriatrics Society
George P Smith
Since the beginning of the hospice movement in 1967, "total pain management" has been the declared goal of hospice care. Palliating the whole person's physical, psychosocial, and spiritual states or conditions is central to managing the pain that induces suffering. At the end-stage of life, an inextricable component of the ethics of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. This Article urges wider consideration and use of terminal sedation, or sedation until death, as an efficacious palliative treatment and as a reasonable medical procedure in order to safeguard the "right" to a dignified death...
2011: Cornell Journal of Law and Public Policy
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