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  • Review Article
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Sedation for the care of patients with advanced cancer

Abstract

Sedation in the context of palliative medicine is the monitored use of medications to induce varying degrees of unconsciousness to bring about a state of decreased or absent awareness (i.e. unconsciousness) in order to relieve the burden of otherwise intractable suffering. Sedation is used in palliative care in several settings: transient controlled sedation, sedation in the management of refractory symptoms at the end of life, emergency sedation, respite sedation, and sedation for refractory psychological or existential suffering. Sedation is controversial in that it diminishes the capacity of the patient to interact, function, and, in some cases, live. There is no distinct ethical problem in the use of sedation to relieve otherwise intolerable suffering in patients who are dying. Since all medical treatments involve risks and benefits, each potential option must be evaluated for its promise with regards to achieving the goals of care. When risks of treatment are involved, to be justified these risks must be proportionate to the gravity of the clinical indication. Some aspects of management, such as the need for hydration in patients undergoing sedation and the use of sedation in the management of psychological and spiritual suffering, remain controversial.

Key Points

  • Sedation is an important tool for managing otherwise uncontrollable symptoms in patients with advanced and incurable disease

  • At the end of life, sedation is an important therapy for managing refractory symptoms such as dyspnea, pain and agitated delirium

  • Sedation is also used in other settings, such as transient noxious procedures and respite

  • Sedation in the management of psychological or existential symptoms remains controversial and requires particular caution

  • Adherence to carefully constructed guidelines, clinical transparency and consent are all necessary to ensure that sedation is not abused by physicians seeking to deliberately end their patients' lives

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Correspondence to Nathan I Cherny.

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Cherny, N. Sedation for the care of patients with advanced cancer. Nat Rev Clin Oncol 3, 492–500 (2006). https://doi.org/10.1038/ncponc0583

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