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Is sedation at the end of life compatible with the principles of palliative care?
  1. Antonia Dean1,
  2. Barbara Beard2
  1. 1Department of Education, The Hospice of St Francis, Berkhamsted, UK
  2. 2Sheffield Hallam University, Sheffield, UK
  1. Correspondence to Antonia Dean, antonia.dean{at}stfrancis.org.uk

Abstract

Palliative sedation has been a matter of clinical debate for many years, largely due to uncertainty surrounding whether it may hasten death. Recently, it has also come under public and media scrutiny as part of the review of end-of-life practices initiated by concerns about the Liverpool Care Pathway for the Dying Patient (LCP). Research indicates palliative sedation is unlikely to shorten life, although robust evidence is lacking. While some view it as an essential tool for effective palliative care, others have voiced concerns that sedation silences patients, removing autonomy and medicalising the dying process. Implementing sedation within established guidelines that emphasise justification of aims and intent, communication with patients and relatives, and proportionate titration, may improve care. However, it remains an ethically and legally complex area, and education of healthcare professionals is vital in supporting them with decision-making. This article seeks to consider whether palliative sedation is compatible with the principles of palliative care. Areas of further research are identified and recommendations for practice are made, but it is concluded that clinicians would be doing patients a disservice if this procedure were not available to patients who have a clinical need.

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