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August 2011, Volume 41 Number 8 , p 50 - 54


  • Paul R. Arnstein PhD, RN, FAAN
  • Ellen M. Robinson PhD, RN


Your dying patient has uncontrollable distress, and the physician ordered a consult for palliative sedation. You've heard this is like euthanasia. Is it legal and ethical for you to provide palliative sedation even if a qualified physician orders it?DESPITE REMARKABLE ADVANCES in pain and symptom management, some patients continue to experience unbearable discomfort in the final hours and days of life. Palliative sedation is the monitored suppression of consciousness to alleviate uncontrollable distressing symptoms when all other strategies have failed.1 When used appropriately, palliative sedation is aligned with the nursing responsibilities of advocacy, protecting the dignity of dying patients, and alleviating their suffering with skilled, compassionate care.2The decision to utilize palliative sedation isn't entered into lightly. It requires a series of conversations with the responsible physician, interdisciplinary treatment team, patient, and family. You may coordinate these conversations and should be present during deliberations. While these conversations can be highly emotional with conflicting points of view, you can feel assured that palliative sedation, in the right circumstances with the right intentions, is both legally and ethically permissible.Palliative sedation differs from euthanasia and physician-assisted suicide. Euthanasia is the deliberate termination of a person's life by another person to ease that person's suffering. In physician-assisted suicide, medications and instructions are provided to help suffering patients intentionally end their lives. Euthanasia isn't ethically or legally permissible; physician-assisted suicide is legally permissible in some jurisdictions, but its ethical justifications are less clear.The American Nurses Association and other professional organizations have policies or position statements that support the premise of palliative sedation (see Who supports palliative sedation?). The ethical justification can be summarized

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