Skip to main content
AAHPM Logo
Login
  • Join/Renew
  • Donate
  • Blog
  • Contact
Menu Search Account
  • Membership
    • Join/Renew
      • Member Benefits
    • Diversity, Equity & Inclusion
      • DEI Resources
    • Member Center
    • Getting Involved
    • Communities
      • SIG Instructions
      • Join a SIG
      • Member Councils
    • Mentoring
    • FAAHPM
      • Current Fellows
  • Education & Practice
    • Writing Instructional Objectives
    • Meetings
      • Leadership Forum: Ascend
      • Annual Assembly
        • Back to Meetings
        • Assembly Home
        • About the Assembly
          • Why Attend
        • Registration
        • Special Events
        • Educational Sessions
          • Keynotes
          • Wednesday
          • Thursday
          • Friday
          • Saturday
        • Plan Your Experience
        • CE and MOC
        • Summer Call for Abstracts
        • Fall Call for Abstracts
        • Assembly FAQs
        • Business Meeting
        • Health and Safety
        • Exhibits & Advertising
      • State of the Science
      • State of the Science
        • Back to Meetings
        • State of the Science Home
        • Plan Your Experience
        • Schedule and Pricing
        • SOTS FAQ
        • Virtual State of the Science
      • Intensive Review Course
        • Back to Meetings
        • Home
        • Schedule
        • Plan Your Trip
      • Advanced Course in Pain
        • Back to Meetings
        • Home
        • Plan Your Trip
      • Intensive Board Review Course 2018 Recordings
      • IBRC18 - Additional Management Strategies for Cancer Related Symptoms
      • IBRC18 - Approaches to Care, including Hospice/Medicare
      • IBRC18 - Assessment and Care of the Dying Patient
      • IBRC18 - Communication and Teamwork
      • IBRC18 - Depression/Anxiety & Other Mood Disorders
      • IBRC18 - Ethical and Legal Decision Making
      • IBRC18 - Grief and Bereavement and Spiritual Care
      • IBRC18 - High Yield Pediatrics for the Boards
      • IBRC18 - Non-Pain Symptom Management – GI
      • IBRC18 - Non-Pain Symptom Management – Respiratory
      • IBRC18 - Non-Pain Symptom Management: Pot-Pourri
      • IBRC18 - Pain Management Overview
      • IBRC18 - Palliative Sedation/Physician-Assisted Dying/Discontinuation of Technological Support
      • IBRC18 - Practice Test Question Review Q&A (1)
      • IBRC18 - Practice Test Question Review Q&A (2)
      • IBRC18 - Practice Test Question Review Q&A (3)
      • IBRC18 - Prognostication
      • IBRC18 - Special Topics in Pain Management
      • IBRC18 - Symptom Potpourri
      • IBRC18 - Taking the Test Like a Pro
      • IBRC18 - Urgent Medical Conditions
    • Publications
      • JPSM
        • Members JPSM
      • PC-FACS
        • Members - PC-FACS
      • Quarterly
        • Members Quarterly Full Access
        • Spring 18 Clinical Pearls
        • Spring 18 Diversity & Inclusion
        • Spring 18 Feature
        • Spring 18 HMDCB Update
        • Spring 18 Pathways to Palliative Care
        • Spring 18 Presidents Message
        • Spring 18 Quarterly Progress Report
        • Spring 18 AAHPM News
        • Spring 18 Art of Caring
        • Summer 18 AAHPM News
        • Summer 18 Advocacy Update
        • Summer 18 Annual Assembly
        • Summer 18 Art of Caring
        • Summer 18 Clinical Pearls
        • Summer 18 Ethics
        • Summer 18 Feature
        • Summer 18 HMDCB Update
        • Summer 18 Pathways to Palliative Care
        • Summer 18 President's Message
        • Summer 18 Quarterly Progress Report
        • Fall 18 AAHPM News
        • Fall 18 Annual Assembly
        • Fall 18 Art of Caring
        • Fall 18 Clinical Pearls
        • Fall 18 Diversity & Inclusion
        • Fall 18 Feature
        • Fall 18 HMDCB Update
        • Fall 18 Pathways to Palliative Care
        • Fall 18 President's Message
        • Fall 18 Quarterly Progress Report
        • Winter 18 AAHPM News
        • Winter 18 Advocacy Update
        • Winter 18 Annual Assembly
        • Winter 18 Art of Caring
        • Winter 18 Clinical Pearls
        • Winter 18 Ethics
        • Winter 18 Feature
        • Winter 18 Pathways to Palliative Care
        • Winter 18 President's Message
        • Winter 18 Quarterly Progress Report
        • Winter 18 HMDCB Update
        • Spring 19 Editors Message
        • Spring 19 Meet the President
        • Spring 19 Clinical Pearls
        • Spring 19 Art of Caring
        • Spring 19 Advocacy Update
        • Spring 19 Feature
        • Spring 19 Pathways to Palliative Care
        • Spring 19 Diversity and Inclusion
        • Spring 19 Quarterly Progress Report
        • Spring 19 HMDCB Update
        • Spring 19 AAHPM News
        • Summer 19 Presidents Message
        • Summer 19 Clinical Pearls
        • Summer 19 Art of Caring
        • Summer 19 Annual Assembly
        • Summer 19 Advocacy Update
        • Summer 19 Feature
        • Summer 19 Pathways to Palliative Care
        • Summer 19 Ethics and the Hidden Curriculum
        • Summer 19 Research or Quality Improvement
        • Summer 19 Quarterly Progress Report
        • Summer 19 HMDCB Update
        • Summer 19 AAHPM News
        • Fall 19 Presidents Message
        • Fall 19 Clinical Pearls
        • Fall 19 Art of Caring
        • Fall 19 Annual Assembly
        • Fall 19 Advocacy Update
        • Fall 19 Feature
        • Fall 19 Pathways to Palliative Care
        • Fall 19 Diversity, Equity, & Inclusion
        • Fall 19 Quality Improvement
        • Fall 19 Quarterly Progress Report
        • Fall 19 HMDCB Update
        • Fall 19 AAHPM News
        • Fall 19 State of the Science
        • Winter 19 Presidents Message
        • Winter 19 Editor's Message
        • Winter 19 Clinical Pearls
        • Winter 19 Art of Caring
        • Winter 19 Annual Assembly
        • Winter 19 Advocacy Update
        • Winter 19 Feature
        • Winter 19 Pathways to Palliative Care
        • Winter 19 Quarterly Progress Report
        • Winter 19 State of the Science
        • Winter 19 HMDCB Update
        • Winter 19 AAHPM News
        • Spring 20 Presidents Message
        • Spring 20 Meet the President
        • Spring 20 Clinical Pearls
        • Spring 20 Diversity, Equity, & Inclusion
        • Spring 20 Art of Caring
        • Spring 20 Advocacy Update
        • Spring 20 Feature
        • Spring 20 Pathways to Palliative Care
        • Spring 20 Quarterly Progress Report
        • Spring 20 HMDCB Update
        • Spring 20 AAHPM News
        • Summer 20 Presidents Message
        • Summer 20 Meet New AAHPM CEO
        • Summer 20 Annual Assembly
        • Summer 20 State of the Science
        • Summer 20 Clinical Pearls
        • Summer 20 Art of Caring
        • Summer 20 Advocacy Update
        • Summer 20 Feature
        • Summer 20 Pathways to Palliative Care
        • Summer 20 Quarterly Progress Report
        • Summer 20 AAHPM News
        • Summer 20 HMDCB Update
        • Summer 20 PCQC Update
        • Fall 20 Presidents Message
        • Fall 20 Art of Caring
        • Fall 20 Annual Assembly
        • Fall 20 Clinical Pearls
        • Fall 20 Lets Think About it Again
        • Fall 20 Advocacy Update
        • Fall 20 Feature
        • Fall 20 Pathways to Palliative Care
        • Fall 20 Diversity, Equity, & Inclusion
        • Fall 20 Quarterly Progress Report
        • Fall 20 HMDCB Update
        • Fall 20 PCQC Update
        • Winter 20 Presidents Message
        • Winter 20 Annual Assembly
        • Winter 20 Clinical Pearls
        • Winter 20 Lets Think About it Again
        • Winter 20 Art of Caring
        • Winter 20 Advocacy Update
        • Winter 20 Feature
        • Winter 20 Pathways to Palliative Care
        • Winter 20 Diversity, Equity, & Inclusion
        • Winter 20 Quarterly Progress Report
        • Winter 20 HMDCB Update
        • Winter 20 PCQC Update
        • Winter 20 AAHPM News
        • Spring 21 A Message from the CEO
        • Spring 21 Meet the President
        • Spring 21 Clinical Pearls
        • Spring 21 Art of Caring
        • Spring 21 Interview with AAFP President
        • Spring 21 Advocacy Update
        • Spring 21 Feature
        • Spring 21 Pathways to Palliative Care
        • Spring 21 Lets Think About it Again
        • Spring 21 Diversity, Equity, & Inclusion
        • Spring 21 Quarterly Progress Report
        • Spring 21 HMDCB Update
        • Spring 21 PCQC Update
        • Spring 21 AAHPM News
        • Summer 21 A Message from the President
        • Summer 21 Annual Assembly
        • Summer 21 Clinical Pearls
        • Summer 21 Art of Caring
        • Summer 21 Advocacy Update
        • Summer 21 Feature
        • Summer 21 Pathways to Palliative Care
        • Summer 21 Lets Think About it Again
        • Summer 21 Quarterly Progress Report
        • Summer 21 HMDCB Update
        • Summer 21 PCQC Update
        • Summer 21 AAHPM News
        • Fall 21 A Message from the President
        • Fall 21 State of Science
        • Fall 21 Annual Assembly
        • Fall 21 Clinical Pearls
        • Fall 21 Advocacy Update
        • Fall 21 Feature
        • Fall 21 Pathways to Palliative Care
        • Fall 21 Lets Think About it Again
        • Fall 21 Diversity, Equity, & Inclusion
        • Fall 21 Quarterly Progress Report
        • Fall 21 Art of Caring
        • Fall 21 HMDCB Update
        • Fall 21 PCQC Update
        • Winter 21 A Message from the President
        • Winter 21 The Bridge Builder
        • Winter 21 Clinical Pearls
        • Winter 21 Art of Caring
        • Winter 21 Advocacy Update
        • Winter 21 Feature
        • Winter 21 Pathways to Palliative Care
        • Winter 21 Lets Think About it Again
        • Winter 21 Quarterly Progress Report
        • Winter 21 Partner Updates
        • Winter 21 AAHPM News
        • Spring 22 Meet the President
        • Spring 22 Clinical Pearls
        • Spring 22 Art of Caring
        • Spring 22 Advocacy Update
        • Spring 22 Feature
        • Spring 22 Pathways to Palliative Care
        • Spring 22 Lets Think About It Again
        • Spring 22 DEI LAB
        • Spring 22 Quarterly Progress Report
        • Spring 22 AAHPM Partner Update
        • Spring 22 AAHPM News
        • AAHPM Quarterly: Spring 2022 (Full Issue)
        • Summer 22 A Message from the President
        • Summer 22 Clinical Pearls
        • Summer 22 Art of Caring
        • Summer 22 Advocacy Update
        • Summer 22 Feature
        • Summer 22 DEI LAB
        • Summer 22 Quarterly Progress Report
        • AAHPM Quarterly: Summer 2022 (Full Issue)
      • SmartBriefs
    • AAHPM Learn
      • Interactive Activities
    • Self-Study
      • Board Prep Materials
      • Essentials
      • Primer
      • HPM PASS
      • HPM FAST
        • HPM FAST CME
      • Hospice Products
        • HMD Manual
        • HMD PREP
      • Opioid REMS
      • hpmpasscme
      • Opioid Resources
    • Fellowships
      • Competencies
        • Pediatric Competencies
      • Accreditation
      • NRMP Match
      • Grants
        • Ho/Chiang Foundation
      • Hospice Program Toolkit
      • CBME Recordings
    • CME
    • Quality
      • Measuring What Matters
      • Quality Reporting
      • Quality Resources
      • Quality Registries
      • Quality Improvement Education
    • Research
      • Research Funding
      • Successful Research Grants
    • COVID-19 Resources
    • COVID hotel
  • Advocacy
    • Stay Informed
    • Take Action
    • Key Issues
      • Opioids
      • Workforce
  • Career Development
    • Jobs
      • Virtual Career Fair
    • Clinical Training
      • Additional Training
    • Leadership Development
      • AAHPM Ascend
        • Leadership Forum Faculty and Facilitators
        • Ascend Schedule
        • Ascend Facilitators
    • Certification
      • Allopathic
      • Hospice
        • HMDCB Research
      • Osteopathic
    • Continuing HPM Certification
    • Workforce Statistics
    • Scholarships
      • Access Fund
      • Leadership Scholars
      • International Physicians
      • Pediatric Scholarship
      • Research Scholars
      • Next Gen Scholars
    • Resilience and Well-being
  • About
    • History
    • Position Statements
      • Access to Palliative Care and Hospice Position Statement
      • Artificial Nutrition Position Statement
      • Research Ethics Position Statement
      • Palliative Sedation Position Statement
      • Physician-Assisted Dying Position Statement
      • Withholding Position Statement
      • Physician Assisted Dying Position Statement Review
      • Physician-Assisted Dying
    • Talking About HPM
      • Advance Directives-Talking HPM
      • Choosing a Hospice Program-Talking HPM
      • Defining HPM-Talking HPM
      • Explaining PAD-Talking HPM
      • Costs-Talking HPM
      • Withdrawing LST-Talking HPM
      • Choosing Wisely
      • Members Talking About HPM
    • Governance
      • Board of Directors
        • Board Only
        • Past Presidents
      • Committees
      • Staff
        • Staff
      • Call for Nominations
      • Revised Bylaws
    • Giving Center
      • Reasons to Give
      • AAHPM Giving Circle
      • Year End Donations
      • Giving Tuesday Donations
      • Bogetz Educational Fund
      • Donation Form
      • Donation FAQ
    • Awards
      • Visionaries in HPM
      • Emerging Leaders
    • Social Media
  • AAHPM Learn
    • Browse All
    • Books
    • Core Content
    • Self-Study
    • Essentials
  • Legislative Action Center
  • My Account
  • Username & Password
  • Manage Credit Cards
  • Demographics
  • My Classroom
  • Quarterly Newsletter
  • Pay Open Balances
  • Purchase History
  • Membership Details
  • My Communities
  • My Volunteer History
  • Uploaded Documents
  • History
  • Position Statements
    • Access to Palliative Care and Hospice Position Statement
    • Artificial Nutrition Position Statement
    • Research Ethics Position Statement
    • Palliative Sedation Position Statement
    • Physician-Assisted Dying Position Statement
    • Withholding Position Statement
    • Physician Assisted Dying Position Statement Review
    • Physician-Assisted Dying
  • Talking About HPM
    • Advance Directives-Talking HPM
    • Choosing a Hospice Program-Talking HPM
    • Defining HPM-Talking HPM
    • Explaining PAD-Talking HPM
    • Costs-Talking HPM
    • Withdrawing LST-Talking HPM
    • Choosing Wisely
    • Members Talking About HPM
  • Governance
    • Board of Directors
    • Committees
    • Staff
    • Call for Nominations
    • Revised Bylaws
  • Giving Center
    • Reasons to Give
    • AAHPM Giving Circle
    • Year End Donations
    • Giving Tuesday Donations
    • Bogetz Educational Fund
    • Donation Form
    • Donation FAQ
  • Awards
    • Visionaries in HPM
    • Emerging Leaders
  • Social Media

Statement on Palliative Sedation

Approved by the AAHPM Board of Directors on December 5, 2014

Background

Palliative care supports patients whose diseases are associated with significant burden. Distressing symptoms exist on a spectrum from the most easily treated to the most refractory. Although preservation of awareness at the end of life is viewed as a priority for many, for some, the relief of symptoms may outweigh the desire to be conscious. Palliative sedation (PS), as defined in this statement, is the intentional lowering of awareness towards, and including, unconsciousness for patients with severe and refractory symptoms.

Statement

A primary objective of palliative medicine is the easing of suffering via pharmacologic and non-pharmacologic techniques. As with any medical procedure, PS must satisfy the criteria of having a specific clinical indication, a target outcome, and a benefit/risk ratio that is acceptable to both the clinician and patient. Palliative sedation is an intervention reserved for extreme situations. The use of palliative sedation should only be considered after all available expertise to manage the target symptom has been accessed. The level of sedation should be proportionate to the patient's level of distress. As with all treatments, patients, when able, should participate in the decision to use palliative sedation. Treatment of other symptoms should be continued alongside palliative sedation, because sedation may decrease the
patient's ability to communicate or display discomfort.

Palliative sedation raises ethical concerns when it significantly reduces patient consciousness to the degree that the patient is unable to substantially interact with others, does not have the ability or opportunity to change his mind, and is unable to eat and drink (thus potentially shortening survival in particular circumstances). Palliative sedation is ethically defensible when used 1) after careful interdisciplinary evaluation and treatment of the patient, and 2) when palliative treatments that are not intended to affect consciousness have failed or, in the judgment of the clinician, are very likely to fail, 3) where its use is not expected to shorten the patient's time to death, and 4) only for the actual or expected duration of symptoms. Palliative sedation should not be considered irreversible in all circumstances. It may be appropriate, in some clinical situations when symptoms are deemed temporary,
to decrease sedation after a predetermined time to assess efficacy, continued symptoms and need for ongoing sedation.

In clinical practice, palliative sedation usually does not alter the timing or mechanism of a patient's death, as refractory symptoms are most often associated with very advanced terminal illness. Practitioners who use palliative sedation should be clear in their intent to palliate symptoms and to
not shorten survival. Because patients receiving palliative sedation are typically close to death, most patients will no longer have desire to eat or drink. Artificial nutrition and hydration are not generally expected to benefit the patient receiving palliative sedation, however questions about the use of artificial nutrition and hydration should be addressed before palliative sedation is undertaken. (See AAHPM Position Statement of Artificial Nutrition and Hydration Near the End of Life).

There is no clear consensus or scientific evidence regarding the most appropriate medication(s) to effect palliative sedation. As elsewhere in medicine, the agent should be selected based on safety, efficacy, and availability.

Although the Academy recognizes that existential distress may cause patients to experience suffering of significant magnitude, there is no consensus around the ability to define, assess, and gauge existential suffering, to measure the efficacy of treatments for existential distress, and whether it is in the realm of medicine to palliate such suffering when it occurs absent of physical symptoms. Patients with existential suffering should be thoroughly assessed and treated through vigorous multidisciplinary efforts which may include involving professionals who are not usual members of the palliative care team (e.g., experts in psychological, family therapy, or specific spiritual services). If palliative sedation is used for truly refractory existential suffering, as for its use for physical symptoms, it should not shorten survival.

 

 

Bibliography

Broeckaert, B. (2011). Palliative sedation, physician-assisted suicide, and euthanasia: "Same, same but different"? AJOB, 11, 62 – 64.

Cherny, N.I., Radbruch, L., for the Board of the European Association for Palliative Care. (2009). European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care, Journal of Clinical Oncology, 23, 581 – 593.

Claessens, P. Menten, J., Schotsmans, P., Broeckaert, B. (2008). Palliative sedation: A review of the research literature. Journal of Pain & Symptom Management, 36, 310 – 333.

Claessens, P. Menten, J., Schotsmans, P., Broeckaert, B. on behalf of the Palsed Consortium. (2011). Palliative sedation, not slow euthanasia: A prospective, longitudinal study of sedation in Flemish Palliative Care Units. Journal of Pain & Symptom Management, 41, 14 – 24.

Kirk, T.W., & Mahon, M. M. (2010). National Hospice & Palliative Care Organization (NHPCO) position statement and commentary on the use of palliative sedation in immediately dying terminally ill patients. Journal of Pain & Symptom Management, 39, 914 – 923.

Kon, A.A. (2011). Palliative sedation: It's not a panacea. AJOB, 11, 41 – 42.

Maltoni, M., Scarpi, E., Rosati, M., Derni, S., Fabbri, L., Martini, F., Amadori, D., & Nanni, O. (2012). Palliative sedation in end-of-life care and survival: A systematic review. Journal of Clinical Oncology, 30, 1378 – 1383.

Morita, T., Akechi, T., Sugawara, Y., Chihara, S., & Uchitomo, Y. (2002). Practices and attitudes of Japanese oncologists and palliative care physicians concerning terminal sedation: A nationwide survey. Journal of Clinical Oncology, 20, 758 – 764.

Olsen, M.L., Swetz, K.M., Mueller, P.S. (2010). Ethical decision making with end of life care: Palliative sedation and withholding or withdrawing life-sustaining treatments. Mayo Clin Prac, 85, 949 – 954.

Powers, C.L. & McLean, P.C. (2011). The community speaks: Continuous deep sedation as caregiving versus physician-assisted suicide as killing. AJOB, 11, 65 -66.

Quill, T.E., Lo, B., Brock, D.W. (2009). Last-resort options for palliative sedation. Annals of Internal Medicine, 141, 421 – 424

Schildmann & Schildmann. (2014) Palliative sedation therapy: a systematic literature review and critical appraisal of available guidance on indication and decision making. J Palliat Med, 17(5):601-611.

Vacco vs. Quill, 117 S.Ct. 2293 (1997).

Washington v. Glucksberg, 117 S.Ct. 2258 (1997).

 

Read other AAHPM position statements.

 

 

AAHPM Membership

Access all benefits of membership including discounts on events and product, access to timely journals, and the opportunity to connect with colleagues in HPM.

Learn More

Quick Links

  • Job Mart
  • JPSM
  • CME/CE Certificates
  • Purchased Activities
  • Terms and Conditions
  • Privacy Policy

For Exhibitors and Advertisers

  • Commercial Support
  • Exhibiting
  • Advertising
  • Mailing Labels

For Students and Residents

  • Membership
  • Careers
  • Fellowships
  • Publications
Facebook Twitter Linked In Visit our patient website: PalliativeDoctors.org

AAHPM Logo

8735 West Higgins Road, Suite 300 Chicago, IL 60631

Phone 847-375-4712 Fax 847-375-6475 E-mail info@aahpm.org

Copyright © American Academy of Hospice and Palliative Medicine