Palliative sedation: A safety net for the relief of refractory and intolerable symptoms at the end of life.

Abstract

Evidence exists for the use of palliative sedation for people approaching the last days of life with refractory and intolerable symptoms. It is a third-line intervention that deliberately lowers the conscious state to relieve intolerable and refractory symptoms. This level of intervention is not routinely used in primary care, and there is a lack of guidelines for palliative sedation in thiscontext. This article provides some key information about palliative sedation and global issues faced by all individuals involved. A tertiary centre case study is used to illustrate the key points. Given this form of therapy may be required for palliative patients in the community, another aim of this article is to provide an overview for primary care practitioners to raise their awareness of such therapy and the issues relatedto it. While palliative sedation has been regarded as 'controversial' in early palliative care literature, there has beenan increased effort to formulate standardised guidelines to define and ethically justify this procedure.