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What is palliative sedation?

By Dr. Patrick Vinay, president of Living with Dignity, former dean of the Medical Faculty of Université de Montréal

Sedation is a medical procedure that is part of everyday medical practice. Sedation translates the search, by medicinal means, for a decrease in alertness. It is mainly used in intensive care for seriously ill patients by reducing the caloric needs of people who can no longer eat naturally. It is a healing tool.

In palliative care, sedation seeks a decrease in alertness that can go as far as loss of consciousness. Its goal is to reduce or eliminate the patient’s perception of a situation experienced as unbearable while all the means available and adapted to the situation have been implemented without making it possible to obtain the expected relief. It is therefore a medical procedure of last resort, with its indications, conditions and methods of application. The medication used is safe and always the same. When the sedation is temporary or intermittent, it constitutes a respite from the crisis situation and allows therapeutic adjustments while immediately relieving the patient. When it is continuous, it maintains relief that cannot be obtained otherwise and it is then often maintained until death because the source of the distress cannot be stopped. The patient’s analgesic medication is of course maintained under sedation, because it does not eliminate the pain or its effects. Sedation is therefore an essential option in the therapeutic arsenal applicable at the end of life.

Like any therapeutic gesture, continuous sedation can cause complications. These could affect the lifespan of the sedated patient, particularly in exceptional situations where the dosages required to ensure patient comfort are higher. But this situation is rare and is never the result of an aim of euthanasia: there is no desire to interrupt life here.

Continuous palliative sedation leads to cessation of feeding and hydration, which could shorten the life of a patient if administered to a patient with a long prognosis for survival (several weeks) and still capable to eat and hydrate. Indeed, it is commonly accepted in medicine that the capacity of survival of a sick human being decreases rapidly beyond a week without hydration. Maintaining artificial hydration (solutes) during continuous sedation at the very end of life is, however, not advisable because of the risks of fluid overload at the end of life. This is why continuous palliative sedation is mainly administered to a terminally ill person whose death is imminent, that is to say, whose prognosis for survival is very short. Few patients require continuous palliative sedation more than a week before their death. Various publications demonstrate that neither analgesic medication nor properly administered continuous palliative sedation accelerates death.

Translated by Maxime Huot Couture