Results 14.6% (n = 80) of the patients in palliative care had sedation given by the intravenous route in the last 48 hrs of their life according to internal guidelines. The annual frequency to apply sedation increased continuously from 7% in 1995 to 19% in 2002. Main indications shifted from refractory control of physical symptoms (dyspnoea, gastrointestinal, pain, bleeding and agitated delirium) to more psychological distress (panic-stricken fear, severe depression, refractory insomnia and other forms of affective decompensation). Patients' and relatives' requests for sedation in the final phase were significantly more frequent during the period 2000–2002.

Conclusion

Sedation in the terminal or final phase of life plays an increasing role in the management of intractable physical and psychological distress. Ethical concerns are raised by patients' requests and needs on the one hand, and the physicians' self-understanding on the other hand. Hence, ethically acceptable criteria and guidelines for the decision making are needed with special regard to the nature of refractory and intolerable symptoms, patients' informed consent and personal needs, the goals and aims of medical sedation in end-of-life care.

Keywords

terminal sedation palliative care ethics symptom control attitudes advance directives'/>

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Sedation in palliative care – a critical analysis of 7 years experience

BMC Palliative Care20032:2

DOI: 10.1186/1472-684X-2-2

Received: 14 February 2003

Accepted: 13 May 2003

Published: 13 May 2003

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Original Submission
14 Feb 2003 Submitted Original manuscript
Resubmission - Version 2
Submitted Manuscript version 2
25 Feb 2003 Reviewed Reviewer Report - Tatsuya Morita
5 Mar 2003 Reviewed Reviewer Report - Lukas Radbruch
22 Apr 2003 Author responded Author comments - H.Christof Muller-Busch
Resubmission - Version 3
22 Apr 2003 Submitted Manuscript version 3
Resubmission - Version 4
Submitted Manuscript version 4
1 May 2003 Reviewed Reviewer Report - Tatsuya Morita
7 May 2003 Reviewed Reviewer Report - Lukas Radbruch
10 May 2003 Author responded Author comments - H.Christof Muller-Busch
Resubmission - Version 5
10 May 2003 Submitted Manuscript version 5
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13 May 2003 Editorially accepted
13 May 2003 Article published 10.1186/1472-684X-2-2

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Authors’ Affiliations

(1)
Department of Palliative Medicine, Gemeinschaftskrankenhaus Havelhoehe
(2)
University Witten/Herdecke

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