Is sedation at the end of life compatible with the principles of palliative care?

Antonia Dean, Barbara Beard

  • Abstract

    Palliative sedation has been a matter of clinical debate for many years, largely due to uncertainty surrounding whether it may hasten death. Recently, it has also come under public and media scrutiny as part of the review of end-of-life practices initiated by concerns about the Liverpool Care Pathway for the Dying Patient (LCP). Research indicates palliative sedation is unlikely to shorten life, although robust evidence is lacking. While some view it as an essential tool for effective palliative care, others have voiced concerns that sedation silences patients, removing autonomy and medicalising the dying process. Implementing sedation within established guidelines that emphasise justification of aims and intent, communication with patients and relatives, and proportionate titration, may improve care. However, it remains an ethically and legally complex area, and education of healthcare professionals is vital in supporting them with decision-making. This article seeks to consider whether palliative sedation is compatible with the principles of palliative care. Areas of further research are identified and recommendations for practice are made, but it is concluded that clinicians would be doing patients a disservice if this procedure were not available to patients who have a clinical need.

  • Contributors

    Antonia Dean, Barbara Beard

    Affiliations

    Correct at article publish date

    1 Department of Education, The Hospice of St Francis, Berkhamsted, UK
    2 Sheffield Hallam University, Sheffield, UK

    Author notes

    Correspondence to Antonia Dean, antonia.dean@stfrancis.org.uk

    Original publishing information

    • Publisher: St Christopher's Hospice
    • Publish date: 01/07/2015
    • ePub Date: 20/07/2015
    • Volume: 5
    • Issue: 1

    Permissions: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions2015

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