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Ethical Issues

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Other difficult questions can arise from the potentially negative value that is culturally assigned to detaching oneself, or "zoning out," as a lower form of coping. Should the anxious patient who no longer wants to face the anxiety associated with the end of life and who wants to be sedated be encouraged to work through such issues? Or is it allowable for these patients to have sedation for dealing with their anxiety? How many alternatives should be tried before anxiety is considered unacceptable? When dealing with such requests, professionals should consider their own cultural and religious biases and the cultural and/or religious backgrounds of patients and their families.

Few studies detail the use of terminal sedation for psychosocial symptoms. Four palliative care programs in Israel, South Africa, and Spain participated in one survey.[19] One unique study has described the Japanese experience around the issues of palliative sedation therapy.[20,21] A retrospective study at the MD Anderson Cancer Center in Houston included 1,207 patients admitted to the palliative care unit. Palliative sedation was used in 15% of admissions. The most common indications were delirium (82%) and dyspnea (6%). Sedation in these circumstances is often on a temporary basis and was reversible in 23% of this group of patients.[22]

References:

  1. McCallum PD, Fornari A: Nutrition in palliative care. In: Elliott L, Molseed LL, McCallum PD, eds.: The Clinical Guide to Oncology Nutrition. 2nd ed. Chicago, Ill: American Dietetic Association, 2006, pp 201-7.
  2. Torelli GF, Campos AC, Meguid MM: Use of TPN in terminally ill cancer patients. Nutrition 15 (9): 665-7, 1999.
  3. Statement on Artificial Nutrition and Hydration Near the End of Life. Glenview, Ill: American Academy of Hospice and Palliative Medicine, 2006. Available online. Last accessed January 3, 2013.
  4. Langdon DS, Hunt A, Pope J, et al.: Nutrition support at the end of life: opinions of Louisiana dietitians. J Am Diet Assoc 102 (6): 837-40, 2002.
  5. Maillet JO, Potter RL, Heller L: Position of the American Dietetic Association: ethical and legal issues in nutrition, hydration, and feeding. J Am Diet Assoc 102 (5): 716-26, 2002.
  6. Balboni TA, Vanderwerker LC, Block SD, et al.: Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol 25 (5): 555-60, 2007.
  7. Wright AA, Zhang B, Ray A, et al.: Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300 (14): 1665-73, 2008.
  8. Miyashita M, Morita T, Sato K, et al.: Factors contributing to evaluation of a good death from the bereaved family member's perspective. Psychooncology 17 (6): 612-20, 2008.
  9. Zhukovsky DS, Hwang JP, Palmer JL, et al.: Wide variation in content of inpatient do-not-resuscitate order forms used at National Cancer Institute-designated cancer centers in the United States. Support Care Cancer 17 (2): 109-15, 2009.
  10. von Gunten CF, Weissman DE: Ventilator Withdrawal Protocol, Part 1, 2nd ed. Milwaukee: Medical College of Wisconsin, End-of-Life Palliative Education Resource Center, 2005. Available online. Last accessed January 3, 2013.
  11. Marr L, Weissman DE: Withdrawal of ventilatory support from the dying adult patient. J Support Oncol 2 (3): 283-8, 2004 May-Jun.
  12. Heytens L, Verlooy J, Gheuens J, et al.: Lazarus sign and extensor posturing in a brain-dead patient. Case report. J Neurosurg 71 (3): 449-51, 1989.
  13. Truog RD, Cist AF, Brackett SE, et al.: Recommendations for end-of-life care in the intensive care unit: The Ethics Committee of the Society of Critical Care Medicine. Crit Care Med 29 (12): 2332-48, 2001.
  14. Campbell ML, Bizek KS, Thill M: Patient responses during rapid terminal weaning from mechanical ventilation: a prospective study. Crit Care Med 27 (1): 73-7, 1999.
  15. Truog RD, Burns JP, Mitchell C, et al.: Pharmacologic paralysis and withdrawal of mechanical ventilation at the end of life. N Engl J Med 342 (7): 508-11, 2000.
  16. van Dooren S, van Veluw HT, van Zuylen L, et al.: Exploration of concerns of relatives during continuous palliative sedation of their family members with cancer. J Pain Symptom Manage 38 (3): 452-9, 2009.
  17. Cherny NI, Radbruch L; Board of the European Association for Palliative Care.: European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 23 (7): 581-93, 2009.
  18. American Academy of Hospice and Palliative Medicine.: Statement on Palliative Sedation. Glenview, Ill: AAHPM, 2006. Available online. Last accessed January 3, 2013.
  19. Fainsinger RL, Waller A, Bercovici M, et al.: A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients. Palliat Med 14 (4): 257-65, 2000.
  20. Morita T, Chinone Y, Ikenaga M, et al.: Ethical validity of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manage 30 (4): 308-19, 2005.
  21. Morita T, Chinone Y, Ikenaga M, et al.: Efficacy and safety of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manage 30 (4): 320-8, 2005.
  22. Elsayem A, Curry Iii E, Boohene J, et al.: Use of palliative sedation for intractable symptoms in the palliative care unit of a comprehensive cancer center. Support Care Cancer 17 (1): 53-9, 2009.

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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