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Invited Commentary
March 8, 2010

Palliative Sedation: Need for Consensus Guidelines and Standards: Comment on “Continuous Deep Sedation Until Death in Belgium: A Nationwide Survey”

Author Affiliations

Author Affiliations: Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University, Nijmegen Medical Center, Nijmegen, the Netherlands.

Arch Intern Med. 2010;170(5):494-495. doi:10.1001/archinternmed.2010.12

The first publications on the intentional lowering of consciousness in patients with distressing and refractory symptoms at the end of life appeared in the 1990s. In 2001, Morita et al1 proposed to define palliative sedation as the use of sedative medications (not narcotics) specifically to relieve intolerable and refractory distress by a reduction of patient consciousness. This document highlights 2 important principles: (1) the intentional lowering of consciousness by the use of sedatives, and (2) the distinction between light/deep and intermittent/continuous sedation. However, there has been very little study of palliative sedation, and there are no well-accepted guidelines that rigorously outline the best methods and standards of effective palliative sedation.2

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