Timothy E. Quill, MD; Ira R. Byock, MD
Quill T., Byock I.; Responding to Intractable Terminal Suffering. Ann Intern Med. 2000;133:561-562. doi: 10.7326/0003-4819-133-7-200010030-00022
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Published: Ann Intern Med. 2000;133(7):561-562.
Yanow and Krakauer are concerned about misinterpretation of the term terminal sedation. This term was chosen after considerable discussion within the College's End-of-Life Care Consensus Panel. Dr. Yanow rightly sees that we are distinguishing terminal sedation from the usual situation of “double effect,” in which death is unintended but the increased risk for death is foreseen (1). He fears that adverse judicial interpretation of a physician's intention in cases of terminal sedation may cause physicians to underprescribe in other settings.
Dr. Krakauer notes that “palliative sedation,” sometimes called “heavy sedation,” is used to relieve severe symptoms in other circumstances (for example, burn patients who require extensive, painful debridement) (Goldstein-Shirley J, Jennings B, Rosen E. Total sedation in hospice and palliative care. In preparation). The expectation for survival and the use of other life-prolonging therapies help to distinguish “palliative sedation” or “heavy sedation” from the subcategory of “terminal sedation.” Terminal sedation usually precludes the concomitant use of life-sustaining therapies such as artificial ventilation and hydration. The expectation is that the patient will remain sedated until death.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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