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Use of palliative sedation in Belgium has almost doubled in recent years
Established guidelines would likely help improve care at the end of life.
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The use of deep palliative sedation almost doubled from 2001 to 2007 in Flanders, Belgium, according to a research letter published in the Archives of Internal Medicine. The trend toward increasing use of sedation existed across all care settings, sexes, age groups and in patients with various causes of death.
“Although euthanasia is legal in Belgium since 2002, it is possible that some physicians and patients view continuous deep sedation as a psychologically and medically preferable alternative to euthanasia,” the researchers wrote.
The research letter, submitted by Kenneth Chambaere, MA, of the End-of-Life Care Research Group in Brussels, Belgium, and colleagues detailed the results of a physician questionnaire about certain end-of-life practices. The survey, originally conducted in 2001, was repeated in 2007. In it, in reference to continuous deep sedation, physicians were asked, “Was the patients continuously and deeply sedated until death by the use of one or more drugs?”
Questions regarding which drugs were used, the duration of sedation, administration of artificial nutrition or hydration, and patient or family consent were also asked.
In the 2007 survey, 14.5% of physicians reported using continuous deep sedation compared with 8.2% in 2001. In 83% of the cases, opioids were the sole drug administered. General consensus of palliative sedation is to first use benzodiazepines or, if those fail, propofol.
Survey results indicated that in 20% of all sedated patients, patient or family consent was not obtained before sedation; this also occurred in 27% of hospitalized patients. In addition, survey respondents reported that in 17% of cases, there was a co-intention to hasten death.
Kris C.P. Vissers, MD, PhD,and Jeroen G.J. Hasselaar, MSc, of the department of anesthesiology, pain and palliative medicine at Radboud University, Nijmegen Medical Center, the Netherlands, wrote an invited commentary accompanying this study. In it, they commented on the overall need for consensus guidelines and standards in the use of continuous palliative sedation.
“It is striking that the performance of palliative sedation showed considerable aberrations from proposed guidelines and recommendations. Consent from the patients and/or proxy was obtained in a fairly low percentage of the cases, and the sole use of opioids for palliative sedation was substantial,” the researchers wrote.
In addition, they wrote that the existence of a co-intention to hasten death in 17% of cases suggested that “continuous deep sedation is frequently inadequately performed and ethically questionable.”
“Enhanced consensus guidelines, if implemented effectively, should result in improved care of terminally ill patients at the end of life,” they wrote.
Chambaere K. Arch Intern Med. 2010;170:490-493.
Vissers KCP. Arch Intern Med. 2010;170:494-495.
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