Palliative sedation is an important and
necessary intervention for patients
experiencing refractory suffering. For its safe
and optimal conduction, appropriate
regulations, carefully developed procedural
guidelines, and the right use of medicines
and medical devices are desirable. As these
elements may either favour or hinder the
performance of high-quality palliative
sedation, this chapter attempts to
summarize the main features of existing
regulations, clinical recommendations
provided in guidelines and the use of
medications and equipment in sedation. This
way, an understanding of the practice of
palliative sedation is provided for eight
European countries: Belgium, Germany,
Hungary, Italy, the Netherlands, Romania,
Spain and the United Kingdom.
that concern normal medical practice and
contain relevant elements for it. For
instance, countries like Belgium, Germany,
Hungary, the Netherlands and the United
Kingdom have general healthcare laws that
regulate sedation-related principles: the
obligation of doctors to honour advance
directives, informed consent, the
participatory decision-making process and
the obligation to document the whole
indication, process and outcome. On the
other hand, other countries -whose general
health laws do also apply to the palliative
sedation-related principles-, also regulate
sedation mostly through regional End-of-life
laws (this is the case of Spain) and through
the law of informed consent and advance
directives (in Italy). In both Spain and Italy,
regulations specifically recognise palliative
sedation as a right of the patient at the end
of life when they are suffering from
refractory symptoms.
Introduction
Regulations affecting
palliative sedation
Regulations might restrict and condition
certain medical practices, therefore,
indirectly influencing the frequency of use
and quality of palliative sedation. Actually,
the regulation of this practice may facilitate
its distinction with euthanasia, and this could
be relevant both to countries allowing and
not allowing euthanasia. In this sense, an
overview of what regulations are stated
regarding palliative sedation can ameliorate
professionals´ confidence in this practice.
Across the eight countries, over thirty
documents regulating palliative sedation
were identified. (1) These states have
adopted different regulatory options,
although the majority do regulate palliative
sedation through general healthcare laws
Importantly, palliative sedation in Germany,
the Netherlands and the United Kingdom is
also regulated through professional
guidelines that are binding as good practice
with legal significance. (2) These documents
rely on the recommendations produced by
German medical associations in Germany,
the Dutch Medical Association in the
Netherlands, and the General Medical
Council in the United Kingdom.
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