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Care at the Close of Life: Evidence and Experience
Stephen J. McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz
Part F Ethical Issues
Chapter 31. Palliative Sedation in Dying Patients: “We Turn to It When Everything Else Hasn’t Worked”
Bernard Lo, MD, Gordon Rubenfeld, MD, MSc
Forming a Detailed Plan for Palliative Sedation


Topics Discussed: clinician behavior, communication, incorporating patient values and preferences, opioids, pain management, palliative care, physician-patient relations, sedation procedure, sedative

Excerpt: "Caregivers, as well as patients and relatives, naturally have strong emotional reactions when a terminal patient experiences severe distress; they may be uncertain, ambivalent, or confused about the options for care and their ethical acceptability.39-42 It is essential that the health care team be clear about the justification for proportionate palliative sedation and the details of care.The agreement of the patient or surrogate is ethically important both to respect the patient's autonomy and to help him/her reach closure. The health care team needs to offer emotional support and help the patient or surrogate think through complicated ethical issues. Consultation with the ethics committee, the hospital chaplain, or the patient's own religious or spiritual adviser may be useful...."
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