Terminal Sedation for Intractable Distress.

James Hallenbeck, Terminal Sedation for Intractable Distress, 171 W. J. MED. 222 (1999).

Terminal sedation is the induction and maintenance of a sedated state with the intent of relieving otherwise intractable distress, both physical and mental, in a patient close to death. It is a way of providing relief to patients in the final phase of dying. In giving terminal sedation, the intent should focus on relieving distress, not deliberately hastening death.

When other usual methods for relieving such suffering have failed, terminal sedation may be indicated for patients who suffer from either physical symptoms, such as pain or dyspnea, or mental distress. Often, during the final phase of dying, it is impossible to sort out physical from mental distress. Patients may be irreversibly delirious, a state that tends not to clear by withholding essential medications such as opioids for pain. While extreme distress and severe pain occur infrequently, lesser degrees of agitation and distress are more common. The frequency of symptoms at which sedation is appropriate is a topic open to debate.

Informed consent should be obtained prior to initiating terminal sedation. The goals, benefits, and burdens of sedation should be discussed and documented. Most patients who could be appropriately considered for sedation will have already stopped eating and drinking, a natural occurrence in the final phase of dying. If sedation will interfere with eating or drinking...