From the Norman Levan Chair of Humanistic Medicine and Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
Author's disclosure of potential conflicts of interest are found at the end of this article.
Address reprint requests to Nathan Cherny, MBBS, FRACP, FRCP, Norman Levan Chair of Humanistic Medicine, Associate Professor of Medicine (BGU) and Director, Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, 12 Shmu'el Bait St, PO Box 3235, Israel 91031; e-mail: chernyn{at}netvision.net.il
Overview: In the context of palliative medicine, sedation is the monitored use of medications intended to induce varying degrees of unconsciousness to create a state of decreased or absent awareness (unconsciousness) to relieve the burden of otherwise intractable suffering. Sedation is used in palliative care in several settings: transient-controlled sedation, sedation in the management of refractory symptoms at the end of life, emergency sedation, respite sedation, and sedation for refractory psychologic or existential suffering. Sedation is controversial, insofar as it diminishes the capacity to interact, function, and, in some cases, to live. There is no distinct ethical problem in the use of sedation to relieve otherwise intolerable suffering for patients who are dying. Because all medical treatments involve risks and benefits, each potential option must be evaluated for their potential to achieve the goals of care. Where risks of treatment are involved, the risks must be proportionate to the gravity of the clinical indication. However, some aspects, such as the place of hydration and the use of sedation in the management of psychologic and spiritual suffering, remain controversial.
