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Inattention to potential risks and problematic practices can lead to harmful and unethical practices such as the abusive, injudicious or unskilled use of sedation.Abuse of palliative sedation occurs when clinicians sedate patients approaching the end of life with the primary goal of hastening the patient's death [16–23].The aim is to provide adequate relief of distress in a manner that is ethically acceptable to the patient, family and health care providers.Apart from its use for patients undergoing noxious procedures and in weaning from ventilator support, sedation is a treatment of last resort because of its anticipated adverse outcomes and potential risks.Their data indicate that, even when matched for adverse prognostic variables, sedated patients in this setting did not have an accelerated demise. It is important to note that in this study, the vast majority of patients were lightly sedated.Could it be that that light sedation has no effect on survival and that sudden deep sedation does?
Distress for family members which may relate to several factors, including the impaired ability to interact with the patient, anticipatory grief, confusion or disagreement regarding the indications for the use of sedation, and perceptions that the decision to resort to sedation was precipitous, or perhaps inappropriately delayed, or the perception that sedation directly, or even indirectly, hastens death [3–7].
If there were enough patients who refused sedation for the management of catastrophic symptoms at the end of life, a matched cohort study may provide the answer.
In the meantime, we need not be paralyzed by uncertainty.
This issue, as to whether sedation of patients to relieve refractory distress at the end of life hastens death, is significant to all the stakeholders: the patient, their family and the health care providers.
The issue is critical to the discourse with patients and their families, informed consent and to the ethical deliberations essential in every case.