Terminal sedation

In medicine, specifically in end-of-life care, palliative sedation (also known as terminal sedation, continuous deep sedation, or sedation for intractable distress in the dying/of a dying patient) is the palliative practice of relieving distress in a terminally ill person in the last hours or days of a dying patient's life, usually by means of a continuous intravenous or subcutaneous infusion of a sedative drug, or by means of a specialized catheter designed to provide comfortable and discreet administration of ongoing medications via the rectal route.

Palliative sedation is an option of last resort for patients whose symptoms cannot be controlled by any other means. It is not a form of euthanasia, as the goal of palliative sedation is to control symptoms, rather than to shorten the patient's life.

According to 2009 research, 16.5% of all deaths in the United Kingdom during 2007–2008 took place after continuous deep sedation.

On the other hand, a 2009 survey of almost 4000 U.K. patients whose care had followed the Liverpool Care Pathway for the dying patient found that while 31% had received low doses of medication to control distress from agitation or restlessness, only 4% had required higher doses.

Palliative sedation is often initiated at the patient's request. It can also be initiated by the physician who would discuss the option with the patient and family. Palliative sedation can be used for short periods with the plan to awaken the patient after a given time period, making terminal sedation a less correct term. The patient is sedated while symptom control is attempted, then the patient is awakened to see if symptom control is achieved. In some cases, palliative sedation is begun with the plan to not attempt to reawaken the patient.

One such common example is a patient with an enlarging cancer in the throat that compresses the trachea in a patient who does not want intubation or a tracheostomy, so that eventually symptom control is impossible. Instead of experiencing death by suffocation, once symptoms are intolerable some patients will request palliative sedation to ease their symptoms as death approaches.

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