Clinical and Pharmacological Guidelines for Palliative Sedation

To assist in decision-making regarding the use of palliative sedation, guidelines have been proposed, including the concept of respite sedation, a procedure that involves temporary and time-limited sedation (Rousseau 2001).

Although specific criteria for palliative sedation are lacking, basic, but not all-inclusive, criteria include (Table 1):

• the presence of a terminal illness with a refractory symptom(s);
• a do-not-resuscitate (DNR) order;
• exhaustion of all palliative treatments directed at the symptom(s), including treatment for depression, delirium, anxiety, and any other contributing disorders;
• consideration of ethical and psychiatric consultations;
• assessment for spiritual issues by a skilled clinician or clergy member;
• discussion regarding the continuance of nutritional support or intravenous or subcutaneous hydration in patients receiving such treatments;
• obtaining informed consent; and
• consideration of a trial of respite sedation in selected cases.