4.5 Article

Ethical validity of palliative sedation therapy: A multicenter, prospective, observational study conducted on specialized palliative care units in Japan

Journal

JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
Volume 30, Issue 4, Pages 308-319

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jpainsymman.2005.03.016

Keywords

palliative sedation therapy; refractory symptoms; palliative care; neoplasms; ethics

Ask authors/readers for more resources

Although palliative sedation therapy is often required in terminally ill cancer patients to achieve acceptable symptom relief, empirical data supporting the ethical validity of this approach are lacking. The primary aim of this study was to systematically investigate whether empirical evidence supports the ethical validity of sedation. This was a multicenter, prospective, observational study, which was conducted by 21. specialized palliative care units in,japan. One-hundred two consecutive adult cancer patients who received continuous deep sedation were enrolled. Continuous deep sedation was defined as the continuous use of sedative medications to relieve intolerable and refractory distress by achieving almost or complele unconsciousness until death. Prior to the stndy, we conceptualized the ethical validity Of sedation from the viewpoints of physicians intent, Proportionality, and autonomy. Sedation was performed mainly with midazolam and phenobarbital. The initial doses of midazolam and phenobarbital were 1.5 mg/hour and 20 mg/hour respectively. Main administration routes were continuous subcutaneous infusion, and continuous intravenous infusion, and no rapid intravenous injection, was reported. Of 59 patients who received artificial hydration or could intake adequate fluids/foods orally before sedation, 63% received artificial hydration. therapy after sedation, and in the artificial hydration, was withheld or withdrawn due to fluid retention symplovis and/or patient wishes. Of 66 patients who ware able to verbally express themselves, 95% explicilty slated that symploms were intolerable. The etiologies of the symptoms requiring sedation were primarily related to 91, the progression of such as cancer cachexia and and and standard palliative treatments had failed: steroids in 68% of patients with fatigue, of opoids in 95% of patients with dyspnea, antisecretion. medications in 75% of patients with bronchial secretion, antipsychotic medications in 74% of patients with delirium, and opioids in all patients with pain. On the basis of the Palliative Prognostic Index, 94% of the patients were Predicted to die within. 3 weeks. Before sedation, 67% 4) the patients expressed explicit wishes for sedation. In. the remaining 34 patients, previous wishes for sedation were-noted in 4 patients, and in the other 30 patients, the families were involved \in the decision-making process. The chief reason for patient nan-involvement, in the decision-making was cognitive impairment. These data indicate that palliative sedation, therapy performed in specialized palliative care units in Japan generally followed the principles of double effect, proportionality, and autonomy.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.5
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available