SEDATION FOR INTRACTABLE DISTRESS IN THE DYING - A SURVEY OF EXPERTS

'Terminal sedation' is a phrase that has appeared in the palliative ca re literature in the last few years. There has not been a clear defini tion proposed for this term, nor has there been any agreement on the f requency with which the technique is used. A postal survey of 61 selec ted palliative care experts (59 physicians, two nurses) was carried ou t to examine their response to a proposed definition for 'terminal sed ation', to estimate the frequency of this practice and the reasons for its use, to identify the drugs and dosages used, to determine the out come, and to explore the decisionmaking process. Opinions on physician -assisted suicide and voluntary euthanasia were also sought. Eighty-se ven per cent of the experts responded from eight countries, although p redominantly from Canada and the United Kingdom. Forty per cent agreed unequivocally with the proposed definition, while 4% disagreed comple tely. Eighty-nine per cent agreed that 'terminal sedation' is sometime s necessary and 77% reported using it in the last 12 months - over hal f of these for up to four patients. Reasons for using this method incl uded various physical and psychological symptoms. The most common drug s used were midazolam and me methotrimeprazine. Decision making usuall y involved the patient or family, and varied with respect to the ease with which the decision was made. The use of sedation was perceived to be successful in 90 out of 100 patients recalled. Ninety per cent of respondents did not support legalization of euthanasia. In conclusion, sedating agents are used by palliative care experts as tools for the management of symptoms. The term 'terminal sedation' should be abandon ed and replaced with the phrase 'sedation for intractable distress in the dying'. Further research into the management of intractable sympto ms and suffering is warranted.