others."
Furthermore, the term "mild sedation" is no
longer used, replaced by "light sedation",
since mild and deep are not endpoints of the
same scale or a pair of opposites. The terms
intermittent, continuous, light and deep
sedation have been (more) precisely defined
as follows:
"Continuous sedation: the sedation is
planned for a prolonged period of time
(more than 48 hours), and often until the
moment of death. Continuous deep sedation
is usually indicated in the final stages of life."
"Intermittent palliative sedation (less than
48 hours): may be either administered to
provide temporary relief whilst waiting for
treatment benefit from other therapeutic
approaches (transient sedation) or to give
the patient a break from the current
burdensome situation (respite sedation)
before regaining consciousness. The latter
may be administered on a regular schedule
(e.g. at night)."
"Light sedation: the patient is somnolent,
but responsive, corresponding to the
Richmond Agitation Sedation Scale -
Palliative Version (RASS-PAL) -1 to -3."
"Deep sedation: the patient is asleep and
non-responsive, corresponding RASS-PAL -4
or -5."
Finally, the term "Significant others" is used
in the text to define "any person with a very
close and special relationship to the patient,
with or without family ties".
intended to reduce consciousness in
patients with life-limiting disease. Palliative
sedation has major social and ethical
implications requiring specific considerations
by patients, significant others and care
providers."
In this definition:
• The term refractory suffering is used to
encompass physical and psychological
symptoms as well as existential suffering,
reflecting a shift towards a broader
recognition of refractory existential suffering
as an indication for palliative sedation. The
latter indication is nevertheless subject to
specific recommendations (see Chapter 4).
• The importance of the principle of
proportionality (duration and depth of
sedation should be proportional to the
patient's individual situation) found in the
literature has been acknowledged and
explicitly introduced.
• Palliative sedation is defined in the
accompanying text as a deliberate and
monitored intervention and therefore not an
unintended side effect of medication, such
as from opioids for pain relief.
The criterion of refractoriness has been
further defined as follows:
"Symptoms or a state of existential distress
are considered to be refractory when there
is a lack of methods likely to provide
appropriate relief within an acceptable time
frame and without unacceptable adverse
effects. The notion of refractoriness can be
applied to a single symptom/state or to a
cluster of symptoms/states leading to a
condition which the patient feels is
intolerable. Determining refractoriness is a
joint decision between the physician (and/or
the multi-professional team) and the patient
or their legal representative / significant 17
Infographic
The infographic below (figure 1.2.1) was
commissioned which is available to view in