The ethics of palliative sedation in children
Författare
Summary, in English
At the end of life, when cure or meaningful prolongation of life is no longer available, relief of suffering is the overriding goal. In certain circumstances standard treatments may fall short of this goal, and palliative sedation (PS) to unconsciousness can be applied as a ultimum refugium.
We cared for a 4-year old boy with a brain-stem tumor. In spite of all curative treatment efforts the tumor slowly but steadily progressed. All tumor-directed therapy was eventually abandoned, and together with the family efforts were focused on comfort. The child lost his ability to speak and communication became very difficult, he had difficulties swallowing, got a noisy breathing and was believed to have pain. The child was admitted for titration of pain medication and assessment of any breathing problems. In the course of a few days his condition deteriorated with noisier breathing and signs of continuing pain. The child seemed distressed and anxious, but the degree of symptoms was very difficult to assess with certainty. PS to unconsciousness is begun a week after admission, and continues for 2 weeks before he dies.
The literature concerning PS for children is very sparse, and we want to explore the scope of indication and implementation, from an ethical point of view, for this small but vulnerable population. In what regard, and to which degree, does it matter that the child is not decision competent? Which symptoms, and how severe need they be, to allow PS? For how long can it be given? Can hydration and nutrition be foregone? How stringent need the indication be – or on which side would one prefer to err – in giving or withholding PS? How should the patient be monitored during PS, and why?
We cared for a 4-year old boy with a brain-stem tumor. In spite of all curative treatment efforts the tumor slowly but steadily progressed. All tumor-directed therapy was eventually abandoned, and together with the family efforts were focused on comfort. The child lost his ability to speak and communication became very difficult, he had difficulties swallowing, got a noisy breathing and was believed to have pain. The child was admitted for titration of pain medication and assessment of any breathing problems. In the course of a few days his condition deteriorated with noisier breathing and signs of continuing pain. The child seemed distressed and anxious, but the degree of symptoms was very difficult to assess with certainty. PS to unconsciousness is begun a week after admission, and continues for 2 weeks before he dies.
The literature concerning PS for children is very sparse, and we want to explore the scope of indication and implementation, from an ethical point of view, for this small but vulnerable population. In what regard, and to which degree, does it matter that the child is not decision competent? Which symptoms, and how severe need they be, to allow PS? For how long can it be given? Can hydration and nutrition be foregone? How stringent need the indication be – or on which side would one prefer to err – in giving or withholding PS? How should the patient be monitored during PS, and why?
Avdelning/ar
Publiceringsår
2016
Språk
Engelska
Dokumenttyp
Konferensbidrag: abstract
Ämne
- Medical Ethics
Nyckelord
- palliativ vård
- medicinsk etik
- Pediatrik
- ethics
- pallative
- sedation
Conference name
International Conference on Clinical Ethics Consultation
Conference date
2016-05-19
Conference place
Washington, United States
Aktiv
Published