Continuous sedation until death: State of the art
To be, or not to be: that is the question: Whether ‘tis nobler in the mind to suffer The slings and arrows of outrageous fortune, Or to take arms against a sea of troubles, And by opposing end them? To die: to sleep; No more; and by a sleep to say we end The heart-ache and the thousand natural shocks That flesh is heir to (William Shakespeare, Hamlet Act 3, Scene 1) Introduction In this chapter, the state of the art of continuous sedation until death is discussed with respect to terminology, empirical research, guidelines and regulations. Terms such as ‘palliative sedation’ and ‘terminal sedation’ are explained, critically discussed and subsequently placed in a research framework. An overview is given of research reporting the frequency of use of continuous sedation until death, with special attention to differences and similarities between countries and developments over time. Guidelines about continuous sedation are addressed, in particular the framework recently launched by the European Association for Palliative Care and the Dutch national guideline. Also, findings regarding clinical characteristics of the practice of continuous sedation will be summarised, for example the indications for sedation, and aspects of decision-making (such as involvement of patients, relatives and palliative care experts) and the performance of sedation (such as the type of drugs).