Palliative General Anesthesia at Terminal Extubation: "Go Gentle into that Good Night"

Area of Science:

• Medical Ethics
• Intensive Care Medicine
• Palliative Care

Background:

• Withdrawal of mechanical ventilation, or terminal extubation, is common in intensive care units.
• Current practices use analgesia and sedation, aiming to relieve suffering without hastening death.
• The effectiveness and patient experience of current sedation practices are not well-monitored.

Purpose of the Study:

• To argue for the use of palliative general anesthesia during terminal extubation.
• To address concerns about patient suffering and covert consciousness.
• To challenge current practices based on philosophical concepts of harm.

Main Methods:

• Philosophical analysis of harm and palliative anesthesia.
• Review of evidence on covert consciousness and cognitive-motor dissociation.
• Examination of assumptions underlying current end-of-life care practices.

Main Results:

• Current practices rely on questionable assumptions about patient awareness and monitoring.
• Palliative general anesthesia can safeguard patients from potential suffering during extubation.
• The principle of "first, do no harm" supports general anesthesia in this context.

Conclusions:

• Palliative general anesthesia offers a stronger safeguard against suffering during terminal extubation.
• This approach challenges current practices without engaging in debates on euthanasia.
• The study advocates for a re-evaluation of end-of-life care protocols in intensive care settings.