Careful Conversation about Care at the End of Life
Authors: Tatsuya Morita
Journal: Annals of Internal Medicine (2002)

Letters17 December 2002Careful Conversation about Care at the End of LifeTatsuya Morita, MD, Satoru Tsuneto, MD, PhD, and Yasuo Shima, MDTatsuya Morita, MDSeirei Mikatabara Hospital; Shizuoka 433-8558, JapanOsaka University; Osaka 565-0871, JapanNational Cancer Center Hospital East; Chiba 277-8577, JapanSearch for more papers by this author, Satoru Tsuneto, MD, PhDSeirei Mikatabara Hospital; Shizuoka 433-8558, JapanOsaka University; Osaka 565-0871, JapanNational Cancer Center Hospital East; Chiba 277-8577, JapanSearch for more papers by this author, and Yasuo Shima, MDSeirei Mikatabara Hospital; Shizuoka 433-8558, JapanOsaka University; Osaka 565-0871, JapanNational Cancer Center Hospital East; Chiba 277-8577, JapanSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-12-200212170-00027-w1 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We strongly agree with Jansen and Sulmasy (1) that there are fundamental differences between sedation for patients with psychological distress who are not imminently dying and sedation for imminently dying patients with physical distress. However, we were confused by the definition of sedation and the ethical foundation that Jansen and Sulmasy propose.Consider a man with massive liver metastasis who develops agitated delirium due to untreatable hepatic encephalopathy. Although his physician tries to palliate agitation with intensive antipsychotic medications, with which “reduced consciousness could be foreseen but not intended,” the treatment is unsuccessful. The physician then administers ...Reference1. 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. Breitbart W, Marotta R, Platt MM, Weisman H, Derevenco M, Grau C, et al . A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry. 1996;153:231-7. [PMID: 8561204] CrossrefMedlineGoogle Scholar3. Breitbart W, Jaramillo JR, Chochinov HM. Palliative and terminal care.. In: Holland JC, eds. Psycho-oncology. New York: Oxford Univ Pr; 1998:437-49. Google Scholar4. Casarett DJ, Inouye SK. Diagnosis and management of delirium near the end of life. Ann Intern Med. 2001;135:32-40. [PMID: 11434730] LinkGoogle Scholar5. Morita T, Tsuneto S, Shima Y. Proposed definitions for terminal sedation [Letter]. Lancet. 2001;358:335-6. [PMID: 11501540] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Tatsuya Morita, MD; Satoru Tsuneto, MD, PhD; Yasuo Shima, MDAffiliations: Seirei Mikatabara Hospital; Shizuoka 433-8558, JapanOsaka University; Osaka 565-0871, JapanNational Cancer Center Hospital East; Chiba 277-8577, Japan PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnosis and Management of Delirium near the End of Life David J. Casarett and Sharon K. Inouye , for the American College of Physicians–American Society of Internal Medicine End-of-Life Care Consensus Panel*Sedation, Alimentation, Hydration, and Equivocation: Careful Conversation about Care at the End of Life Lynn A. Jansen and Daniel P. Sulmasy Careful Conversation about Care at the End of Life Charles G. Sasser Careful Conversation about Care at the End of Life Timothy E. Quill Careful Conversation about Care at the End of Life Paul Rousseau Careful Conversation about Care at the End of Life John H. Kvasnicka Careful Conversation about Care at the End of Life Lynn A. Jansen and Daniel P. Sulmasy Physician Involvement in Voluntary Stopping of Eating and Drinking Bernard Gert , James L. Bernat , and R. Peter Mogielnicki Physician Involvement in Voluntary Stopping of Eating and Drinking Lynn A. Jansen and Daniel P. Sulmasy Metrics Cited byEthical Validity of Palliative Sedation Therapy: A Multicenter, Prospective, Observational Study Conducted on Specialized Palliative Care Units in JapanPhysician Reports of Terminal Sedation without Hydration or Nutrition for Patients Nearing Death in the NetherlandsJudith A.C. Rietjens, MSc, Agnes van der Heide, MD, PhD, Astrid M. Vrakking, MSc, Bregje D. Onwuteaka-Philipsen, PhD, Paul J. van der Maas, MD, PhD, and Gerrit van der Wal, MD, PhD 17 December 2002Volume 137, Issue 12 Page: W1 Keywords Brain diseases Consciousness Delirium End of life care Falls Liver Myoclonus Sedation Sedatives Sleep ePublished: 17 December 2002 Issue Published: 17 December 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...