Case study for palliative sedation

An important question here is whether such sedated patients are completely free of pain. Recently however, more sophisticated techniques from the neurosciences have shown that sometimes consciousness and pain are undetectable with these traditional behavioral methods. The aim of this study is to better understand how unconscious palliative sedated patients experience the last days of their life and to find out if they are really free of pain. In this study we will observe 40 patients starting with initiation of palliative sedation until death. Assessment of comfort based on behavioral observations will be related with the results from a NeuroSense monitor, an EEG-based monitor used for evaluation of the adequacy of anesthesia and sedation in the operating room and an ECG-based Analgesia Nociception Index ANI monitor, which informs about comfort or discomfort condition, based on the parasympathetic tone. Measuring pain and awareness in non-communicative dying patients is both technically and ethically challenging.
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Palliative sedation in end-of-life care and survival: a systematic review

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Controlled Sedation for Refractory Suffering - Part 1 - Palliative Care Network of Wisconsin

In medicine , specifically in end-of-life care , palliative sedation also known as terminal sedation , continuous deep sedation , or sedation for intractable distress of a dying patient is the palliative practice of relieving distress in a terminally ill person in the last hours or days of a dying person's life, usually by means of a continuous intravenous or subcutaneous infusion of a sedative drug, or by means of a specialized catheter designed to provide comfortable and discreet administration of ongoing medications via the rectal route. As of , approximately tens of millions of people a year were unable to resolve their needs of physical, psychological, or spiritual suffering at their time of death. Considering the amount of intolerable pain the person must face, palliative care if necessary, palliative sedation can provide a more peaceful and ethical solution for such people. Palliative sedation is an option of last resort for the people whose symptoms cannot be controlled by any other means. It is not a form of euthanasia or physician-assisted suicide , as the goal of palliative sedation is to control symptoms, rather than to shorten or end the person's life. Palliative sedation is legal everywhere and has been administered since the hospice care movement began in the s.
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Controlled Sedation for Refractory Suffering – Part 1

Despite even the best palliative care , some people can't get adequate relief from their suffering and may need what's known as palliative sedation to avoid distress. Before sedation is considered, the team of people caring for you or your loved one—often known as the palliative care team—will look at many possible options to help relieve suffering, such as aggressive symptom management using any and all medications and treatments that may help and mental support to help with emotional concerns. The goal is to make the suffering person as comfortable as possible.
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Last year, a call for "terminal sedation" to be covered by the same legal regulation as euthanasia gave rise to a public debate in The Netherlands. Doctors, supported by the health minister, strongly argued that terminal sedation and the withdrawal of artificial feeding and hydration are "normal medical treatment" and therefore "different from euthanasia" Cf. Sheldon T: "Terminal sedation" different from euthanasia, Dutch ministers agree. BMJ ;
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