Citation

Menten J, Van Oosterom A, Vanden Bogaert W, Vermylen J. Tijdschrift voor Geneeskunde 2004; 60(3): 164-173.

Copyright

(Copyright © 2004)

DOI

10.2143/TVG.60.3.1001792

PMID

unavailable

Abstract

Palliative sedation is a valid alternative for euthanasia or assisted suicide for terminal patients with untreatable symptoms. It can be implemented everywhere in the world without changing the law and it prevents that patients will be left to their suffering. Palliative sedation is an effective (92%) but an exceptional treatment (± 0. 13% and ± 3% of all dying patients in respectively the hospital or in the palliative care unit) for rarely untreatable symptoms at the end of life. Most authors report about physical refractory symptoms as indications for palliative sedation. This study shows that over the last few years a shift has occurred to more existential and psychological indications. The medical decision to start palliative sedation for the individual patient has to be made following an interdisciplinary concertation with respect for the patient's wishes and autonomy. Intermittent sedation can "add life to the last days of life, but should not add days to life". In deeply sedated patients and according to the literature, no shortening of life is seen compared to less deeply sedated patients. Disease progression is the cause of death and not the withdrawal of food and fluid that only limits the prolongation of the dying process. Deep sedation is always based on an individual dose titration, a simple recipe does not exist.

Language: nl

Keywords

adult; human; aged; quality of life; decision making; assisted suicide; cause of death; review; psychological aspect; symptomatology; dying; euthanasia; sedation; validation process; dose calculation; disease course; treatment indication; palliative therapy; terminally ill patient; patient satisfaction; midazolam; propofol; diet restriction; titrimetry; fluid intake