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The ethics of palliative sedation in children

Castor, Anders LU ; Broström, Linus LU and Johansson, Mats LU (2016) International Conference on Clinical Ethics Consultation
Abstract (Swedish)
At the end of life, when cure or meaningful prolongation of life is no longer available, relief of suffering is the overriding goal. In certain circumstances standard treatments may fall short of this goal, and palliative sedation (PS) to unconsciousness can be applied as a ultimum refugium.

We cared for a 4-year old boy with a brain-stem tumor. In spite of all curative treatment efforts the tumor slowly but steadily progressed. All tumor-directed therapy was eventually abandoned, and together with the family efforts were focused on comfort. The child lost his ability to speak and communication became very difficult, he had difficulties swallowing, got a noisy breathing and was believed to have pain. The child was admitted for... (More)
At the end of life, when cure or meaningful prolongation of life is no longer available, relief of suffering is the overriding goal. In certain circumstances standard treatments may fall short of this goal, and palliative sedation (PS) to unconsciousness can be applied as a ultimum refugium.

We cared for a 4-year old boy with a brain-stem tumor. In spite of all curative treatment efforts the tumor slowly but steadily progressed. All tumor-directed therapy was eventually abandoned, and together with the family efforts were focused on comfort. The child lost his ability to speak and communication became very difficult, he had difficulties swallowing, got a noisy breathing and was believed to have pain. The child was admitted for titration of pain medication and assessment of any breathing problems. In the course of a few days his condition deteriorated with noisier breathing and signs of continuing pain. The child seemed distressed and anxious, but the degree of symptoms was very difficult to assess with certainty. PS to unconsciousness is begun a week after admission, and continues for 2 weeks before he dies.

The literature concerning PS for children is very sparse, and we want to explore the scope of indication and implementation, from an ethical point of view, for this small but vulnerable population. In what regard, and to which degree, does it matter that the child is not decision competent? Which symptoms, and how severe need they be, to allow PS? For how long can it be given? Can hydration and nutrition be foregone? How stringent need the indication be – or on which side would one prefer to err – in giving or withholding PS? How should the patient be monitored during PS, and why?
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author
organization
publishing date
type
Contribution to conference
publication status
published
subject
keywords
palliativ vård, medicinsk etik, Pediatrik, ethics , pallative, sedation
conference name
International Conference on Clinical Ethics Consultation
language
English
LU publication?
yes
id
5f261d29-1aa8-41ec-8dcf-a6ecba2325fe
date added to LUP
2016-06-08 08:18:03
date last changed
2016-06-08 15:47:51
@misc{5f261d29-1aa8-41ec-8dcf-a6ecba2325fe,
  abstract     = {At the end of life, when cure or meaningful prolongation of life is no longer available, relief of suffering is the overriding goal. In certain circumstances standard treatments may fall short of this goal, and palliative sedation (PS) to unconsciousness can be applied as a ultimum refugium.<br/><br/>We cared for a 4-year old boy with a brain-stem tumor. In spite of all curative treatment efforts the tumor slowly but steadily progressed. All tumor-directed therapy was eventually abandoned, and together with the family efforts were focused on comfort. The child lost his ability to speak and communication became very difficult, he had difficulties swallowing, got a noisy breathing and was believed to have pain. The child was admitted for titration of pain medication and assessment of any breathing problems. In the course of a few days his condition deteriorated with noisier breathing and signs of continuing pain. The child seemed distressed and anxious, but the degree of symptoms was very difficult to assess with certainty. PS to unconsciousness is begun a week after admission, and continues for 2 weeks before he dies.<br/><br/>The literature concerning PS for children is very sparse, and we want to explore the scope of indication and implementation, from an ethical point of view, for this small but vulnerable population. In what regard, and to which degree, does it matter that the child is not decision competent? Which symptoms, and how severe need they be, to allow PS? For how long can it be given? Can hydration and nutrition be foregone? How stringent need the indication be – or on which side would one prefer to err – in giving or withholding PS? How should the patient be monitored during PS, and why?<br/>},
  author       = {Castor, Anders and Broström, Linus and Johansson, Mats},
  keyword      = {palliativ vård,medicinsk etik,Pediatrik,ethics ,pallative,sedation },
  language     = {eng},
  title        = {The ethics of palliative sedation in children},
  year         = {2016},
}