Justifying Different Levels of Palliative Sedation
Authors: Timothy E. Quill
Journal: Annals of Internal Medicine (2010)

Letters2 March 2010Justifying Different Levels of Palliative SedationTimothy E. Quill, MD, Daniel Brock, MD, Bernard Lo, MD, and Alan Meisel, MDTimothy E. Quill, MDFrom University of Rochester School of Medicine, Rochester, NY 14642; Harvard Medical School, Boston, MA 02115; University of California, San Francisco, San Francisco, CA 94143; and University of Pittsburgh, Pittsburgh, PA 15260.Search for more papers by this author, Daniel Brock, MDFrom University of Rochester School of Medicine, Rochester, NY 14642; Harvard Medical School, Boston, MA 02115; University of California, San Francisco, San Francisco, CA 94143; and University of Pittsburgh, Pittsburgh, PA 15260.Search for more papers by this author, Bernard Lo, MDFrom University of Rochester School of Medicine, Rochester, NY 14642; Harvard Medical School, Boston, MA 02115; University of California, San Francisco, San Francisco, CA 94143; and University of Pittsburgh, Pittsburgh, PA 15260.Search for more papers by this author, and Alan Meisel, MDFrom University of Rochester School of Medicine, Rochester, NY 14642; Harvard Medical School, Boston, MA 02115; University of California, San Francisco, San Francisco, CA 94143; and University of Pittsburgh, Pittsburgh, PA 15260.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-5-201003020-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We generally agree with Dr. Cellarius and Mr. Henry that the main justifications for the different levels of palliative sedation are proportionality and informed consent. For mild levels of distress, mild sedation is appropriate. For more severe distress, heavier sedation (even to the level of unconsciousness) may be needed. With PPS, the level of sedation and the pace of increase are directly related to the severity of otherwise unrelieved suffering. The level of sedation used will be the least amount that can relieve the distress. Although PPS may end with the patient being unresponsive, that is not the ...References1. Jansen LA, Sulmasy DP. Sedation, alimentation, hydration, and equivocation: careful conversation about care at the end of life. Ann Intern Med. 2002;136:845-9. [PMID: 12044133] LinkGoogle Scholar2. Quill TE. Principle of double effect and end-of-life pain management: additional myths and a limited role [Editorial]. J Palliat Med. 1998;1:333-6. [PMID: 15859851] CrossrefMedlineGoogle Scholar3. Quill TE. The ambiguity of clinical intentions. N Engl J Med. 1993;329:1039-40. [PMID: 7690111] CrossrefMedlineGoogle Scholar4. Quill TE, Dresser R, Brock DW. The rule of double effect—a critique of its role in end-of-life decision making. N Engl J Med. 1997;337:1768-71. [PMID: 9392707] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Rochester School of Medicine, Rochester, NY 14642; Harvard Medical School, Boston, MA 02115; University of California, San Francisco, San Francisco, CA 94143; and University of Pittsburgh, Pittsburgh, PA 15260.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSedation, Alimentation, Hydration, and Equivocation: Careful Conversation about Care at the End of Life Lynn A. Jansen and Daniel P. Sulmasy Last-Resort Options for Palliative Sedation Timothy E. Quill , Bernard Lo , Dan W. Brock , and Alan Meisel Justifying Different Levels of Palliative Sedation Victor Cellarius and Blair Henry Justifying Different Levels of Palliative Sedation Daniel P. Sulmasy , Farr Curlin , Gerard S. Brungardt , and Thomas Cavanaugh Metrics Cited ByTrends in Continuous Deep Sedation until Death between 2007 and 2013: A Repeated Nationwide Survey 2 March 2010Volume 152, Issue 5Page: 333KeywordsConflicts of interestDyspneaEuthanasiaHemorrhageNutritionPatient advocacyPulmonary fibrosisReasoningSedationVentilators ePublished: 2 March 2010 Issue Published: 2 March 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...