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Deep continuous patient-requested sedation until death: a multicentric study.
Adrien Serey1, Colombe Tricou1, Nicolas Phan-Hoang1
1Department of Palliative Care, Hospices Civils de Lyon, Lyon, France.
BMJ Supportive & Palliative Care
|April 22, 2019
Summary
Requests for continuous deep sedation until death (CDSUD) are rare in French palliative care. While most requests were delayed, sedation was ultimately granted to a small number of patients, raising ethical considerations.
Area of Science:
- Palliative Care Medicine
- Medical Ethics
- Pharmacology
Background:
- France enacted a law in 2016 allowing continuous deep sedation until death (CDSUD) under specific conditions.
- This study investigates the utilization of this law within palliative care settings.
Purpose of the Study:
- To quantify the frequency of patient requests for CDSUD.
- To analyze patient characteristics and drug regimens associated with CDSUD.
Main Methods:
- Retrospective analysis of medical records from palliative care units (PCU) and palliative care support teams (PCST) in the Rhône-Alpes region.
- Data included patient demographics, reasons for request, drugs used, and adherence to regulatory processes.
Main Results:
- Only 0.5% (42/8500) of patients requested CDSUD, primarily those with cancer, refractory symptoms, and psychoexistential distress.
- Most requests (74%) were delayed, with 31% eventually granted after a mean of 8 days.
- Midazolam was the primary drug used, with dosage variations observed between PCUs and PCSTs.
Conclusions:
- The study reveals a low incidence of CDSUD requests and approvals in specialized palliative care.
- Sedation for psychoexistential distress and incomplete procedural documentation warrant further ethical examination.
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