Symptom Prevalence and Syptom Treatment in Patients Staying at Residential Palliative Care Units. What is the Role of Palliative Sedation?
Symptoomvoorkomen en symptoombehandeling bij patiënten die verblijven op een residentiële palliatieve zorgafdeling. Wat is de rol van palliatieve sedatie?
Claessens, Patricia; M9609272
Problem statement: Patients suffering from a terminal illness often are confronted with severe symptoms during the last phase of their lives. Palliative sedation, although one of the options of last resort, remains a much debated and controversial issue and is often referred to as a form of slow euthanasia or euthanasia in disguise. The available literature on the topic often fails to answer ethical questions concerning this practice. Objectives: The aim of this study was to describe the characteristics of terminally ill patients who are being sedated for refractory symptoms in palliative care units (PCUs) from the time of admission until the day of death. Methods: A prospective, longitudinal, descriptive design was used. Each patient admitted to one of the 8 participating units was included if they met the inclusion criteria and gave informed consent. Data were gathered, three times a week, with regard to demographics, medication, food and fluid intake, decision making, level of consciousness and symptom experience. If patients received palliative sedation, extra variables were assessed. Results: Of all included patients (n=266), 7.5% received palliative sedation. Sedation started on average 2.5 days before death and in half of these patients the form of sedation changed over time. At the start of sedation, patients were at the end stage of their illness and needed total care. Patients reported on average 2 refractory symptoms and all patients gave consent to start palliative sedation because of increased suffering. When patients entered the PCU they had a normal food and fluid intake. A reduction of food and fluid intake could be observed during the last days of their life. Moreover at the day palliative sedation started patients only had little sips of water. Only 3 of the sedated patients received artifical fluid when entering the PCU, this was continued when palliative sedation was started. Results revealed that 90% of the patients were fully conscious when palliative sedation was started and illustrate that the level of consciousness gradually declines until the day of death. Conclusion: Palliative sedation is nor slow euthanasia nor an ambivalent practice. It is an intentional medical treatment which is administered in a proportioanl way when - in extraordinary situations and at the very end of the dying process - refractory suffering occurs.