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Sedation indicated?-rethinking existential suffering: a narrative review.

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Annals of Palliative Medicine
|March 11, 2024
PubMed
Summary

Existential suffering (ES) requires holistic care, not just sedation. Existential Analysis aids professionals in understanding and addressing the root causes of patient despair and hopelessness.

Keywords:
Existential AnalysisExistential sufferingempathic distresspalliative sedation therapytriad of existential suffering

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Area of Science:

  • Palliative Care
  • Existential Psychology
  • Medical Ethics

Background:

  • Existential suffering (ES) is a complex, poorly understood phenomenon in palliative care.
  • Current frameworks often lack consensus on ES assessment, definition, and treatment.
  • The appellative nature of ES frequently leads to palliative sedation as a primary, yet potentially inadequate, intervention.

Approach:

  • A narrative review of PubMed and specialist literature on Existential Analysis was conducted.
  • Searches covered publications from 1950 to April 2023 in English and German.
  • Methods included reverse and forward snowballing for comprehensive literature retrieval.

Key Points:

  • ES is a multidimensional experience leading to despair, hopelessness, and a wish to die.
  • Pharmacological treatments and sedation fail to address the holistic needs of those with ES.
  • Continuous deep sedation carries increased risks for patients experiencing ES, and burdens caregivers.

Conclusions:

  • Existential Analysis offers a framework to recognize and support underlying moods in patients with ES.
  • Holistic understanding is crucial for alleviating ES and enabling patient transformation.
  • Caregiver training on ES and existential concerns is essential; deep sedation should be a last resort.