“Proportional sedation,” where sedation is titrated to the minimal level of sedation that permits the patient to tolerate the unbearable symptom(s), is the most commonly used approach today, versus deeper sedation practices that had been used more in the past.
pain, vomiting, itching, bleeding, psychological distress, seizures, malaise, panic, clots, fecal retention, etc.). The two most common indications for PS are delirium and dyspnea, but PS has been used to successfully manage myriad other symptoms, as well (e.g. The National Hospice and Palliative Care Organization (NHPCO), American Academy of Hospice and Palliative Medicine (AAHPM), and Hospice & Palliative Nurses Association (HPNA), among other organizations, have issued position statements that may assist clinicians in determining if PS is appropriate. Assessment of core ethical principles assists clinicians in determining if PS is appropriate for a given patient. Euthanasia shares the same goal of decreasing suffering but differs in its intent (to end life), its process (administration of a lethal drug dose), and its immediate outcome (death). The goal of PS is to decrease suffering but not to kill or hasten death. The use of PS in appropriate cases has been repeatedly upheld by the courts, but, as with any treatment, careful ethical consideration by qualified clinicians is necessary. When a patient is unable to communicate, the family should consider whether, based on the known values and wishes of the patient, suffering has reached a level that the patient would declare as intolerable. Intolerable suffering is suffering that is “unbearable,” as described by the patient and verified by the patient’s interdisciplinary team. Intractable suffering is suffering that has not adequately responded to all trialed interventions and for which additional interventions are either unavailable or impractical this may also be described as refractory suffering that cannot be adequately controlled despite aggressive efforts to identify therapy that does not compromise consciousness. physical, psychosocial, spiritual, temporal, and existential). Suffering encompasses the broad range of injuries or threats to one’s being (i.e. Palliative sedation (PS) is defined as the lowering of a dying patient’s consciousness using sedative medications with the intent of limiting patient awareness of intractable and intolerable suffering. Since then, various forms of sedation have found clinical use, from temporary sedation for clinical procedures to palliative sedation to manage distressing symptoms at end-of-life, to name just two examples.
Use of the word transferred to the English language (from the French sedation) in the mid-16th century but did not become a commonly used term until about 1950. The word "sedation" is of Latin derivation, with sedare meaning "to settle, to calm" in Latin.
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