Clinical and Pharmacological Guidelines for Palliative Sedation
To assist in decision-making regarding the use of palliative sedation, guidelines
have been proposed, including the concept of respite sedation, a procedure that
involves temporary and time-limited sedation (Rousseau
2001).
Although specific criteria for palliative sedation are lacking, basic, but
not all-inclusive, criteria include (Table 1):
the presence of a terminal illness with a refractory symptom(s);
a do-not-resuscitate (DNR) order;
exhaustion of all palliative treatments directed at the symptom(s), including
treatment for depression, delirium, anxiety, and any other contributing disorders;
consideration of ethical and psychiatric consultations;
assessment for spiritual issues by a skilled clinician or clergy member;
discussion regarding the continuance of nutritional support or intravenous
or subcutaneous hydration in patients receiving such treatments;
obtaining informed consent; and
consideration of a trial of respite sedation in selected cases.
Suggested Guidelines for Palliative
Sedation
Basic criteria for choosing palliative
sedation:
Presence of a terminal illness with a refractory symptom(s)
A do-not-resuscitate (DNR) order
Exhaustion of all palliative treatments, including treatment for depression,
anxiety, delirium, and familial discord
Consideration of ethical and psychiatric consultations
Consideration of assessment for spiritual issues by a skilled clinician
or clergy member
Discussion regarding the continuance of nutritional support or intravenous
or subcutaneous hydration in patients receiving such treatments
Obtaining informed consent
Consideration of a trial of respite sedation in selected cases
