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Recommended framework for the use of sedation in palliative care
Palliative care provides effective symptom relief and psychosocial care for the vast majority of patients. However, once in a while adequate relief will not be possible. For those patients still suffering severely palliative sedation provides a last resort when other options have failed.
However, there is an intense and ongoing discussion on the definition, indication, and frequency of palliative sedation. Expert groups of the EAPC have tackled the issue for more than nine years, but did not reach consensus on guidelines. In spite of these difficulties guidance is required, as palliative sedation is not without dangers and complications and inadequate use or even misuse has been reported.
As president of the EAPC I am very happy to be able to present not guidelines, but a framework for the development of institutional guidelines. Each organisation can now use this framework to draft their own set of guidelines, taking specific local or regional cultural and social factors into consideration. The framework provides guidance on how to prepare, organize, initiate, titrate, monitor and evaluate the sedation procedure.
I hope that the framework will lead to the development of institutional guidelines in many settings, and I look forward to forthcoming data from these guidelines. The EAPC will be happy about feedback and comments on the guidelines, and hopes that a vivid discussion on the principles of palliative sedation will follow.
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Prof. Dr. Lukas Radbruch
updated: 27 October 2009
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