Terminal sedation is seen by some as euthanasia in disguise4,5 or as slow euthanasia,6 but according to others7-9 the 2 practices are worlds apart. The argument of the latter authors7-9 is that in case of terminal sedation, neither the physician nor the patient aims to cause death.
Palliative sedation is an option of last resort for the people whose symptoms cannot be controlled by any other means. It is not considered a form of euthanasia or physician-assisted suicide, as the goal of palliative sedation is to control symptoms, rather than to shorten or end the person's life.
Popular pre-euthanasia sedation techniques combine an anxiolytic medication like benzodiazepines with phenothiazines, and then with or without the addition of an opioid.
Palliative sedation constitutes administering drugs to render the patient unconscious at the end of life. It is considered part of a normal medical procedure: it does not constitute termination of life because the drugs administered are not the cause of death.
Midazolam is the most common benzodiazepine used for palliative sedation therapy.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
“Palliative sedation is a measure of last resort used at the end of life to relieve severe and refractory symptoms. It is carried out by the administration of sedative medications in supervised settings and is aimed at inducing a state of decreased awareness or absent awareness (unconsciousness).
In contrast to euthanasia and physician-assisted suicide, the intent of palliative sedation is not to cause death, but to relieve suffering. Palliative sedation is only given to relieve severe, unrelieved suffering, and it is only utilized when a patient is already close to death.
Myth: Palliative sedation hastens death. Fact: It is disease progression that causes the body to gradually shut down and eventually die. Patients with poorly controlled pain, shortness of breath, and agitation actually die sooner because of the stress caused by this suffering.
The duration of sedation cannot be determined in advance. In a systematic review including ten studies, the mean duration of palliative sedation ranged from 0.8 to 12.6 days [16]. In contrast, in a review including six studies on palliative sedation at home, the duration ranged from 1 to 3.5 days [34].
The goal of palliative sedation is to relieve intractable symptoms and not to keep the patient unresponsive.
The euthanasia process itself does not hurt, but is similar to going under anesthesia, so your pet may feel odd as they lose consciousness, leading to odd noises or movements. With prior sedation, we can often minimize unusual mannerisms caused by the unconsciousness-inducing effect of the euthanasia solution.
Many people feel it is important to be present during euthanasia. Many others feel unable to handle this traumatic event. And make no mistake: Witnessing the euthanasia of your beloved companion IS traumatic (though it can also help allay fears that your companion suffered).
Combining opioids and midazolam to manage breathlessness and anxiety in the last days of life is common practice in palliative care.
The sedation can also be reversed, so the person is not completely asleep during the dying process. Research has shown that palliative sedation does not shorten life. People die from their disease – not from sedatives.
Without sedation, pet euthanasia can be a very abrupt and confronting process. The final injection is fast acting. With sedation the transition from a conscious pet to passing is a gradual one. Using sedation means the process of saying good bye is much smoother, and peaceful.
The results of our study call attention to the fact that intravenous sedatives may increase pain perception. The effect of sedation on pain perception is agent and pain type specific. Knowledge of these effects provides a rational basis for analgesia and sedation to facilitate medical procedures.
Nursing and other medical staff usually talk to sedated people and tell them what is happening as they may be able to hear even if they can't respond. Some people had only vague memories whilst under sedation. They'd heard voices but couldn't remember the conversations or the people involved.
Nor right to kill oneself through physician assisted suicide or to be killed through active euthanasia is recognized. But terminal sedation, though it does shorten the life of the patient, does not involve taking positive actions aimed at ending the patient's life.
In 36% of the patients, palliative sedation was performed with morphine only. The estimated life shortening due to sedatives (including morphine) was 1 to 4 weeks in 21% and more than 1 month in 6%.
The important findings, along with observations of long-time palliative care doctors and nurses, show: Brain activity supports that a dying patient most likely can hear.
Palliative sedation (also called terminal and total sedation or continuous deep sedation) involves being medicated to reduce consciousness. Typically, the person remains unconscious until death. At the same time, all nutrition and fluids are stopped. Sedation may bring some relief for extreme pain and suffering.
Selection of Appropriate Patient Candidates
Palliative sedation is used when traditional opioid-based therapies are either inadequate to control suffering or cause unacceptable adverse effects. Often, PS is used to treat delirium, pain, dyspnea, nausea, or other physical symptoms.
Some patients need to be sedated for hours, days or even weeks. If they are doing well - waking up, are strong enough, and breathing by themselves - then the breathing tube can usually be taken out. Everyone is different so please ask the ICU nurse or doctor how long your loved one is likely to be sedated for.