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Statement on Palliative Sedation – AAHPM (American Academy of Hospice and Palliative Medicine) 2006

Statement

AAHPM believes that distinctions must be made among the following uses of sedatives in medical practice:

• Ordinary sedation

The ordinary use of sedative medications for the treatment of anxiety, agitated depression, insomnia, or related disorders, in which the goal of treatment is the relief of the symptom without reducing the patient’s level of consciousness.

• Palliative sedation (PS)

The use of sedative medication at least in part to reduce patient awareness of distressing symptoms that are insufficiently controlled by symptom-specific therapies. The level of sedation is proportionate to the patient’s level of distress, and alertness is preserved as much as possible.

• Palliative sedation (PS) to unconsciousness

The administration of sedatives to the point of unconsciousness, when less extreme sedation has not achieved sufficient relief of distressing symptoms. This practice is used only for the most severe, intractable suffering at the very end of life.

Ethical principles and legal rulings support the use of palliative sedation even to the level of unconsciousness to relieve otherwise refractory suffering. With regard to PS, the key ethical features are: 

1. The clinicians’ intent is to relieve suffering,

2. The degree of sedation must be proportionate to the severity of suffering, and

3. The patient should give informed consent; if the patient is not capable of decision-making, the surrogate decision maker should give informed consent consistent with the goals of care and values previously stated by the patient.