Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments.
Summary of "Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments."
Palliative sedation (PS) is the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. Although uncommon, some patients undergoing aggressive symptom control measures still have severe suffering from underlying disease or therapy-related adverse effects. In these circumstances, use of PS is considered. Although the goal is to provide relief in an ethically acceptable way to the patient, family, and health care team, health-care professionals often voice concerns whether such treatment is necessary or whether such treatment equates to physician-assisted suicide or euthanasia. In this review, we frame clinical scenarios in which PS may be considered, summarize the ethical underpinnings of the practice, and further differentiate PS from other forms of end-of-life care, including withholding and/or withdrawing life-sustaining therapy and physician-assisted suicide and euthanasia.
Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States.
This article was published in the following journal.
Name: Mayo Clinic proceedings. Mayo Clinic
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20805544
- DOI: http://dx.doi.org/10.4065/mcp.2010.0201
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Medical and Biotech [MESH] Definitions
Mathematical or statistical procedures used as aids in making a decision. They are frequently used in medical decision-making.
Use of an interactive computer system designed to assist the physician or other health professional in choosing between certain relationships or variables for the purpose of making a diagnostic or therapeutic decision.
Computer-based information systems used to integrate clinical and patient information and provide support for decision-making in patient care.
The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea.
The purpose of this 1990 federal act is to assure that individuals receiving health care services will be given an opportunity to participate in and direct health care decisions affecting themselves. Under this act, hospitals, health care agencies, and health maintenance organizations are responsible for developing patient information for distribution. The information must include patients' rights, advance directives, living wills, ethics committees' consultation and education functions, limited medical treatment (support/comfort care only), mental health treatment, resuscitation, restraints, surrogate decision making and transfer of care. (from JCAHO, Lexicon, 1994)