Hospital Privado de Comunidad, Mar del Plata, National Academy of Medicine, Buenos Aires, Argentina.
Curr Opin Support Palliat Care. 2011 Sep;5(3):279-84. doi: 10.1097/SPC.0b013e3283492acd.
Palliative sedation is a standard procedure used in palliative care especially for patients at the very end of their lives, who are enduring otherwise intractable suffering. It consists of the administration of sedatives and, when necessary, other drugs, usually by infusion, either subcutaneously or intravenously, at the necessary rate to achieve the patient's relief, by means of reducing the consciousness of the patient. If this administration is not discontinued, the usual outcome is the patient's death. So, the most frequent criticisms regarding the procedure are those that consider it as a form of euthanasia. The intention of the review is analyzing the status questionis in Europe and Latin America.
Current thinking and research about this issue refers especially to the terminology, the boundaries between palliative sedation and slow euthanasia, especially in pediatric settings, the lacking of precise definition for concepts such as refractory symptoms and unbearable suffering, and the place for existential suffering in this context; the ethical positioning of Latin-American normative and authors is similar to that of Europe.
It does not seem that solution to the conflicting points will come from better guidelines or more experts' meetings. Instead, efforts should be directed to reinforce moral, professional integrity, within the framework of an ethics of virtue, as inherent to palliative care. Such ethics can effectively be taught and infused, and then required to all healthcare professionals.
缓和镇静是姑息治疗中使用的标准程序，特别是对生命末期、忍受无法控制的痛苦的患者。它包括镇静剂的给予，必要时通过皮下或静脉输注给予其他药物，以必要的速度减轻患者的痛苦，从而降低患者的意识。如果不停止这种给药，通常的结果是患者死亡。因此，该程序最常见的批评意见是认为它是一种安乐死形式。本次综述的目的是分析欧洲和拉丁美洲的现状。
关于这个问题的当前思维和研究特别涉及术语、姑息镇静与缓慢安乐死之间的界限，尤其是在儿科环境中，难以忍受的痛苦和难以忍受的症状等概念缺乏精确的定义，以及存在主义痛苦在这种情况下的位置；拉丁美洲规范和作者的伦理立场与欧洲相似。
似乎解决这些矛盾点不会来自于更好的指南或更多的专家会议。相反，应该努力加强道德、专业诚信，在姑息治疗的美德伦理框架内，因为这是姑息治疗固有的。这种伦理可以有效地被教授和灌输，并要求所有医疗保健专业人员遵守。
