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Citation |
Lübbe AS, Stange JH. Progress in Palliative Care 2009; 17(3): 126-129. |
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Copyright |
(Copyright © 2009) |
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DOI |
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PMID |
unavailable |
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Abstract |
Intractable pain and other intolerable symptoms or the patients' wish to exercise self-determination can mandate palliative sedation. Yet, three bioethical principles must be balanced in comparable situations: one and two being beneficence (to do the best for our patient) and non-maleficence (do no harm) versus patient autonomy (the right for self-determination). Theoretically, palliative sedation incurs the potential risk of accelerating death, particularly in cases in which the disease is not advanced, because the consequences of sedation (perhaps no calorie or fluid uptake) would be likely to cause death (refusal to eat or drink sufficiently). If, however, the disease is far advanced (and the prognosticated life-span short) and the patient unwilling to eat and drink anyway, then initiated sedation might not be associated with accelerated death (and thus do harm to the patient, from an external viewpoint). Therefore, palliative sedation continues to be an area of discussion and a challenge as to when and how to implement it. Here, we introduce the case of a patient with advanced gastric cancer who asked for palliative sedation.We briefly describe his and the family's thoughts and follow the course of the disease until his death. With this report, we re-emphasize that, with precise sedation by continuous infusion of midazolam, it is possible to let the patient wake up for voiding and defecation and communicate with family members. By such individual approaches, it is possible to let the natural course of disease continue. Our patient had at no point in time asked for physician-assisted suicide. © 2009 W.S. Maney & Son Ltd. Language: en |
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Keywords |
adult; human; male; case report; sleep; Euthanasia; health behavior; death; article; hospital admission; sedation; morphine; palliative therapy; patient attitude; Physician-assisted suicide; symptom; cancer pain; low drug dose; midazolam; Sedation; Palliative sedation; drug dose titration; stomach cancer; advanced cancer; liver function test; Palliative medicine; liver metastasis; Supportive care; Terminal phase |