Palliative Sedation And Terminal Weaning For Refractory Symptoms
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Palliative Sedation and Terminal Weaning for Refractory Symptoms
Death is one of the most significant life events people experience. Most people want to die a peaceful death and desire the same outcome for their family and friends. Medical advancements have resulted in people living longer lives with chronic illnesses. Despite the advancements in medicine and the available treatments of today, sometimes the patient is still unable to escape intolerable suffering; the patient’s quality of life diminishes.
Symptoms that are unrelieved after all treatment options have been exhaustion are called refractory, or intractable, symptoms (Knight & Espinosa, 2010). When refractory symptoms are present, palliative sedation (PS) should be considered…show more content… Second, the patient needs to have refractory symptoms (Knight & Espinosa, 2010). A third requirement is a “Do Not Resuscitate” order (Knight & Espinosa, 2010). Lastly, the patient must be expected to die within the next few hours or days (Knight & Espinosa, 2010). Informed consent must be obtained either by the patient, or if the patient is unable to do so, a legal surrogate before palliative sedation is initiated (Knight & Espinosa, 2010). Knight and Espinosa recommended receiving a second opinion as to whether the patient is an appropriate candidate for palliative sedation.
Terminal weaning is when mechanical ventilation is discontinued for a patient expected to die without its support (Knight & Espinosa, 2010). One of the most common methods of discontinuation is through slowly reducing the fraction of inspired oxygen (Knight & Espinosa, 2010). Terminal extubation is the removal of the endotracheal tube, and this can be done “during or after a terminal weaning process” (Knight & Espinosa, 2010, p. 527). Removal of life-supporting interventions is the cause of most deaths in critical care units (Knight & Espinosa, 2010). Knight and Espinosa (2010) discussed palliative sedation and terminal weaning in the same chapter because the two topics go together.
Ethical Considerations & Nursing
Several important ethical considerations exist surrounding the ideas and practices of palliative sedation and