All of us will die, and the vast majority of
chronic progressive diseases. In patients with
very similar biomedical disease
characteristics the level of suffering can vary
dramatically. A 4 cm tumour mass in the
upper lobe of the left lung of a patient may
cause progressive fatigue, anorexia,
hypoactive delirium and death. That same
mass, if located a few cm higher may cause
excruciating pain due to brachial plexopathy,
severe dyspnoea of massive haemoptysis.
The psychosocial and spiritual context of the
patient and significant others can also
greatly influence suffering. Palliative care is
complex, and sometimes none of the
pharmacological and non-pharmacological
interventions by a specialised
interdisciplinary team are successful in
achieving symptom relief. In these cases
palliative sedation can be an invaluable tool
for patients and their significant others.
Unfortunately, over the years there was
wide variation in the definition, decisionmaking process,
administration and
monitoring of palliative sedation. This
practice is frequently poorly understood by
non-specialists and over- or under-used. It is
also a major source of distress and even
litigation among clinicians, and between
clinical teams and significant others.
In this context, a scholarly effort to clarify
the major aspects of this valuable practice
was badly needed. This book has
wonderfully succeeded at clarifying the main
aspects of palliative sedation.
The authors have appropriately decided to
describe the state of the art in knowledge
and practice rather than to oversimplify the
problems of definition, diagnosis of
refractory symptoms, decision making,
choice of drugs and titration, outcome
monitoring, and support for significant
others during palliative sedation.
In well-documented chapters and with a
cohesive style that makes the reading
enjoyable, the authors have covered all the
major aspects of palliative sedation. This
book will be of great help to all those who
practice palliative medicine, and all those
who treat patients with chronic progressive
diseases.
As with all excellent scholarly efforts, this
book raises major questions that require
more research. There are multiple
unanswered questions regarding the
diagnosis of refractory symptoms, decisionmaking, best
drugs and route of
administration, monitoring of sedation, and
counselling of significant others.
This book highlights the lack of attention our
university, academic hospital, and granting
agency leaders have paid to relief for those
among us who will suffer the most at the end
of our lives. All these leaders should be
encouraged to read carefully this important
book.
3
Foreword
by Prof. Eduardo Bruera MD
FT McGraw Chair in the Treatment of Cancer
Chair, Department of Palliative, Rehabilitation, &
Integrative Medicine UT MD Anderson Cancer
Center, Houston, Texas