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Continuous sedation until death

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https://www.readbyqxmd.com/read/29118101/japanese-physicians-experiences-of-terminally-ill-patients-voluntarily-stopping-eating-and-drinking-a-national-survey
#1
Takuya Shinjo, Tatsuya Morita, Daisuke Kiuchi, Masayuki Ikenaga, Hirofumi Abo, Sayaka Maeda, Satoru Tsuneto, Yoshiyuki Kizawa
OBJECTIVES: Voluntarily stopping eating and drinking (VSED) could be regarded as a patients' own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED. METHODS: 219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016...
November 8, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/29102388/-end-of-life-debate-citizen-s-point-of-view-about-deep-and-continuous-sedation
#2
J Toporski, T Jonveaux-Rivasseau, C Lamouille-Chevalier
INTRODUCTION: Sedation in palliative care meets a precise definition and corresponds to a medical practice. We assessed the comprehension of this practice by the French population. METHOD: In 2015, citizen expressed their views on the Claeys-Leonetti bill by means of a consultative forum made available on the Internet site of the National Assembly. The content of the messages filed, regarding the right to deep and continuous sedation until death was analyzed using the ALCESTE textual data analysis software, supplemented by a thematic analysis in order to identify the perception that Internet users had of this practice...
November 1, 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/29056584/the-french-exception-the-right-to-continuous-deep-sedation-at-the-end-of-life
#3
Ruth Horn
In 2016, a law came into force in France granting terminally ill patients the right to continuous deep sedation (CDS) until death. This right was proposed as an alternative to euthanasia and presented as the 'French response' to problems at the end of life. The law draws a distinction between CDS and euthanasia and other forms of sympton control at the end of life. France is the first country in the world to legislate on CDS . This short report describes the particular context and underlying social values that led to this piece of legislation, and explores its meaning in the wider French context...
October 22, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29056564/a-nationwide-survey-about-palliative-sedation-involving-japanese-palliative-care-specialists-intentions-and-key-factors-used-to-determine-sedation-as-proportionally-appropriate
#4
Jun Hamano, Tatsuya Morita, Masayuki Ikenaga, Hirofumi Abo, Yoshiyuki Kizawa, Satoru Tunetou
CONTEXT: Although there has long been debate about physicians' intentions and what physicians consider to be proportionally appropriate when performing palliative sedation, few large studies have been performed. OBJECTIVES: To identify physicians' intentions when starting continuous deep sedation and to clarify what factors determine whether physicians regard sedation as proportionally appropriate in relation to expected survival, the patients' wishes, and refractoriness...
October 19, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28983787/morally-relevant-similarities-and-differences-between-assisted-dying-practices-in-paradigm-and-non-paradigm-circumstances-could-they-inform-regulatory-decisions
#5
Jeffrey Kirby
There has been contentious debate over the years about whether there are morally relevant similarities and differences between the three practices of continuous deep sedation until death, physician-assisted suicide, and voluntary euthanasia. Surprisingly little academic attention has been paid to a comparison of the uses of these practices in the two types of circumstances in which they are typically performed. A comparative domains of ethics analysis methodological approach is used in the paper to compare 1) the use of the three practices in paradigm circumstances, and 2) the use of the practices in paradigm circumstances to their use in non-paradigm circumstances...
October 5, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28735270/subcutaneous-levetiracetam-for-the-management-of-seizures-at-the-end-of-life
#6
REVIEW
Anna Elizabeth Sutherland, John Curtin, Victoria Bradley, Olivia Bush, Maggie Presswood, Victoria Hedges, Katrien Naessens
OBJECTIVES: To report the results of a combined case series analysis of subcutaneous levetiracetam (Keppra) for the management of seizures in palliative care patients. METHODS: A comprehensive literature review on the use of subcutaneous levetiracetam was performed, and these data were combined with a prospective observational audit of its use in terminal care undertaken in a regional palliative care network. RESULTS: 7 papers were identified from the literature review-four case reports and three observational case series-reporting on a total of 53 cases where subcutaneous levetiracetam was administered...
July 22, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28482856/the-impact-of-the-inpatient-practice-of-continuous-deep-sedation-until-death-on-healthcare-professionals-emotional-well-being-a-systematic-review
#7
REVIEW
Sarah Ziegler, Hannes Merker, Margareta Schmid, Milo A Puhan
BACKGROUND: The practice of continuous deep sedation is a challenging clinical intervention with demanding clinical and ethical decision-making. Though current research indicates that healthcare professionals' involvement in such decisions is associated with emotional stress, little is known about sedation-related emotional burden. This study aims to systematically review the evidence on the impact of the inpatient practice of continuous deep sedation until death on healthcare professionals' emotional well-being...
May 8, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28399846/palliative-sedation-challenging-the-professional-competency-of-health-care-providers-and-staff-a-qualitative-focus-group-and-personal-written-narrative-study
#8
Danièle Leboul, Régis Aubry, Jean-Michel Peter, Victor Royer, Jean-François Richard, Frédéric Guirimand
BACKGROUND: Despite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (carers) regarding sedation must be carefully explored if we are to gain a better understanding of its impact and potential pitfalls. The objective of the study was to provide a comprehensive description of the opinions of carers about the use of sedation practices in palliative care units (PCU), which have become a focus of public attention following changes in legislation...
April 11, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28063863/correlation-between-observational-scales-of-sedation-and-comfort-and-bispectral-index-scores
#9
Michael Barbato, Greg Barclay, Jan Potter, Wilf Yeo, Joseph Chung
CONTEXT: When palliative care patients enter the phase of unconsciousness preceding death, it is standard practice to initiate or continue a subcutaneous infusion of an opioid plus or minus a sedative. The doses are determined somewhat empirically and adjustments are based on clinical assessment and observational measures of sedation and comfort. Following reports that these observational measures could be misleading, this study assesses their validity by comparing them with an objective measure of sedation, the Bispectral Index Score (BIS)...
August 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28062650/euthanasia-embedded-in-palliative-care-responses-to-essentialistic-criticisms-of-the-belgian-model-of-integral-end-of-life-care
#10
Jan L Bernheim, Kasper Raus
The Belgian model of 'integral' end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. As a first worldwide, the Flemish PC organisation has embedded euthanasia in its practice. However, some critics have declared the Belgian-model concepts of 'integral PC' and 'palliative futility' to fundamentally contradict the essence of PC. This article analyses the various essentialistic arguments for the incompatibility of euthanasia and PC. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse 'slippery slope' effects...
August 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/27803576/continuous-cervical-epidural-analgesia-in-metastatic-spinal-cord-compression
#11
Mahesh Menon, Nafisa Taha, Navita Purohit, Vatsal Kothari, Shweta Singh
Metastatic spinal cord compression is a devastating complication of cancer. Patients may often require high doses of opioids that may cause side effects, myoclonus being one such. A 63-year-old male suffering from malignant spinal cord compression was admitted to our institution. The primary team managed him conservatively with pharmacotherapy with no relief of pain, and he experienced myoclonus and sedation as adverse effects. A continuous cervical epidural catheter with local anesthetic infusion was inserted for 5 days to control his pain...
October 2016: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/27776894/end-of-life-euthanasia-and-assisted-suicide-an-update-on-the-situation-in-france
#12
REVIEW
R Aubry
On February 2, 2016, the French parliament adopted legislation creating new rights for the terminally ill. The text modifies and reinforces the rights of patients to end-of-life care and strengthens the status of surrogate decision makers. Under the new regulations, advance directives become legally binding though not unenforceable. Two types of advance directives are distinguished depending on whether the person is suffering or not from a serious illness when drafting them. The attending physician must abide by the patient's advance directives except in three situations: there is a life-threatening emergency; the directives are manifestly inappropriate; the directives are not compatible with the patient's medical condition...
December 2016: Revue Neurologique
https://www.readbyqxmd.com/read/27746197/continuous-deep-sedation-a-proposal-for-performing-more-rigorous-empirical-research
#13
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 article 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)...
January 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27380220/a-systematic-literature-review-on-the-ethics-of-palliative-sedation-an-update-2016
#14
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
https://www.readbyqxmd.com/read/27337064/trends-in-continuous-deep-sedation-until-death-between-2007-and-2013-a-repeated-nationwide-survey
#15
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
https://www.readbyqxmd.com/read/27217260/-continuous-sedation-until-death-a-french-way-for-the-end-of-life-care
#16
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
https://www.readbyqxmd.com/read/27211055/distancing-sedation-in-end-of-life-care-from-physician-assisted-suicide-and-euthanasia
#17
REVIEW
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
https://www.readbyqxmd.com/read/27180238/sedation-at-the-end-of-life-a-nation-wide-study-in-palliative-care-units-in-austria
#18
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...
May 14, 2016: BMC Palliative Care
https://www.readbyqxmd.com/read/27013263/-new-act-concerning-end-of-life-impact-for-medical-practice
#19
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
https://www.readbyqxmd.com/read/26715284/continuous-deep-sedation-and-homicide-an-unsolved-problem-in-law-and-professional-morality
#20
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
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