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Palliative Sedation at End of Life – HPNA (Hospice and Palliative Nurses Association) Position Statement

Background

The ethical justification for palliative sedation is based in precepts of dignity, autonomy, beneficence, fidelity, non-malefience, and the rule of double effect. These principles endorse the right of the individual to make health care decisions based on personal values and quality of life considerations, and the responsibility of clinicians to provide humane and compassionate care that is consistent with professional and societal norms.

Position Statement

The Hospice and Palliative Nurses Association (HPNA) is committed to compassionate care of persons at end of life. It is the position of the HPNA Board of Directors to:

• Affirm the value of end of life care that includes aggressive and comprehensive symptom management.
• Affirm the use of palliative sedation to manage refractory and unendurable symptoms in imminently dying patients as one method of aggressive and comprehensive symptom management.
• Assert that hospice and palliative care nurses must possess sufficient knowledge about the issues surrounding the use of palliative sedation to inform patients, families, and other health care providers in making decisions about its use.
• Direct those nurses who choose not to care for patient’s receiving palliative sedation to continue to provide care until responsibility for care is transferred to an equally competent colleague.
• Honor nurses rights to transfer care.
• Affirm that consultation with, psychiatry, ethicists, chaplains, social workers, pharmacists and palliative care specialists may be needed to assure appropriateness of palliative sedation.
• Oppose active euthanasia13 and assisted suicide14 as a means to relieve suffering.