The World Health Organization states that
"palliative care is a crucial part of integrated,
people-centred health services. Relieving
serious health-related suffering, be it
physical, psychological, social, or spiritual, is
a global ethical responsibility."(1) Thus, the
provision of palliative care is - in itself - an
ethical imperative. In the context of
palliative sedation as a means for the relief
of such suffering, in the case of
refractoriness, various issues have been
subject to ethical debates.
As described in previous chapters, the first
statement of the revised framework
presents a definition of palliative sedation:
"Palliative sedation aims to relieve refractory
suffering through the monitored
proportional use of medications intended to
reduce consciousness in patients with lifelimiting disease.
Palliative sedation has major
social and ethical implications requiring
specific considerations by patients,
significant others and care providers."
The inclusion of a declarative sentence
makes this an extended definition going
beyond an explanation of the meaning of a
term by showing that the term or concept
affects people or objects. During all steps of
the Delphi procedure, the extended
definition has been questioned only by
some, and free-text entries to various
statements and the cited literature reflect
the prevalence of a broad ethical discussion
of aspects regarding the indication and
acceptance of palliative sedation.
comments (free text entries) and
recommendations of further references for
statements and accompanying texts.
Introduction
The research within the PalliativeSedation
project into terminology regarding palliative
sedation (see Chapter 2.1), for example,
showed a variety of terms used in the
literature, where the choice of a certain term
may reflect an ethical position. The
outcomes of the revision of the EAPC
framework (see Chapter 4.1) integrated a
careful consideration of the ethical
implications of the terms used and, in the
accompanying texts to the respective
statements, a clarification of not only the
practical but also the ethical context. Ethical
considerations were debated thoroughly in
the Delphi process among 91 participants
with different professional backgrounds (39
female) from 28 countries.
This debate informed the revised framework
by structured analysis and revision of the
Ethical Considerations
when defining Palliative
Sedation
Understanding the intention
of palliative sedation
24 As intention and aim may be used
interchangeably, the revised framework
informs on intention in various statement
contexts. Firstly, in the definition, as cited
above. The accompanying text to this
definition states that it "is a deliberate and
monitored intervention" and "therefore not