Cristin-resultat-ID: 1952130
Sist endret: 26. januar 2022, 13:23
NVI-rapporteringsår: 2021
Resultat
Vitenskapelig artikkel
2021

Ought the level of sedation to be reduced during deep palliative sedation? A clinical and ethical analysis

Bidragsytere:
  • Olav Magnus Fredheim
  • Lars Johan Materstvedt
  • Ingeborg M Skulberg og
  • Morten Magelssen

Tidsskrift

BMJ Supportive & Palliative Care
ISSN 2045-435X
e-ISSN 2045-4368
NVI-nivå 1

Om resultatet

Vitenskapelig artikkel
Publiseringsår: 2021
Open Access

Beskrivelse Beskrivelse

Tittel

Ought the level of sedation to be reduced during deep palliative sedation? A clinical and ethical analysis

Sammendrag

Background Deep palliative sedation (DPS) is applied as a response to refractory suffering at the end of life when symptoms cannot be relieved in an awake state. DPS entails a dilemma of whether to provide uninterrupted sedation—in which case DPS would turn into deep and continuous palliative sedation (DCPS) —to minimise the risk that any further intolerable suffering will occur or whether to pause sedation to avoid unnecessary sedation. DPS is problematic in that it leaves the patient ‘socially dead’ by eradicating their autonomy and conscious experiences. Aim To perform a normative ethical analysis of whether guidelines should recommend attempting to elevate consciousness during DPS. Design A structured analysis based on the four principles of healthcare ethics and consideration of stakeholders’ interests. Results When DPS is initiated it reflects that symptom relief is valued above the patient’s ability to exercise autonomy and experience social interaction. However, if a decrease in symptom burden occurs, waking could be performed without patients experiencing suffering. Such pausing of deep sedation would satisfy the principles of autonomy and beneficence. Certain patients require substantial dose increases to maintain sedation. Waking such patients risks causing distressing symptoms. This does not happen if deep sedation is kept uninterrupted. Thus, the principle of non-maleficence points towards not pausing sedation. The authors’ clinical ethics analysis demonstrates why other stakeholders’ interests do not appear to override arguments in favour of providing uninterrupted sedation. Conclusion Stopping or pausing DPS should always be considered, but should not be routinely attempted.

Bidragsytere

Olav Magnus Fredheim

  • Tilknyttet:
    Forfatter
    ved Nasjonal kompetansetjeneste for pasienter med sammensatte lidelser ved St. Olavs Hospital HF
  • Tilknyttet:
    Forfatter
    ved Institutt for sirkulasjon og bildediagnostikk ved Norges teknisk-naturvitenskapelige universitet
  • Tilknyttet:
    Forfatter
    ved Palliativt senter ved Akershus universitetssykehus HF

Lars Johan Materstvedt

  • Tilknyttet:
    Forfatter
    ved Scotland
  • Tilknyttet:
    Forfatter
    ved Institutt for filosofi og religionsvitenskap ved Norges teknisk-naturvitenskapelige universitet

Ingeborg M Skulberg

  • Tilknyttet:
    Forfatter
    ved Palliativt senter ved Akershus universitetssykehus HF
Aktiv cristin-person

Morten Magelssen

  • Tilknyttet:
    Forfatter
    ved MF vitenskapelig høyskole for teologi, religion og samfunn
  • Tilknyttet:
    Forfatter
    ved Senter for medisinsk etikk ved Universitetet i Oslo
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