|
Abstract
|
BACKGROUND: In the PICU, physicians are confronted with a difficult balance in providing analgesia and sedation. If they provide too little, they risk providing inadequate palliative care. If they administer too much, they may risk prosecution for committing euthanasia.
PURPOSE: To develop consensus guidelines on analgesia and sedation in dying PICU patients, and thus, to help distinguish palliative care from euthanasia.
METHODS: Design: Delphi technique. Sample: Two panels: 1) Academic Pediatric Intensive Care Fellowship program directors and PICU division chiefs in academic centres without a training program (N=10); 2) Deputy chief provincial coroners (N=4); Intervention: Statements about analgesia and sedation in the ICU. Outcome measures: A 7 point Likert scale indicating agreement with the statements, and indication of what modifications to the statement would increase respondent agreement. Analysis: The median value of each statement's ranking was used to determine consensus. A median value of 5.6 (80% agreement) was stipulated a priori to indicate consensus.
RESULTS: After 4 rounds of the Delphi panel, consensus has been achieved on 15 statements including how analgesics and sedatives should be administered to palliate dying patients, how the PICU staff can improve its abilities to assess and treat pain and suffering, when a palliative care consult should be considered, how the intent of the Intensivist administering the analgesics/sedatives can be assessed, and how palliative care can be distinguished from euthanasia/assisted suicide in the ICU.
RESULTS were confirmed by the validation panel.
CONCLUSIONS: We developed consensus guidelines on analgesia and sedation in the PICU that will help distinguish palliative care from euthanasia and assisted suicide. Funded by a University of Toronto postgraduate Department of Medicine fellowship award.
Language: en |