Claessens Patricia, Menten Johan, Schotsmans Paul, Broeckaert Bert
Centre for Biomedical Ethics and Law, Catholic University Leuven, Drongen, Belgium.
Am J Hosp Palliat Care. 2012 May;29(3):195-200. doi: 10.1177/1049909111413890. Epub 2011 Jul 10.
Patients suffering from a terminal illness often are confronted with severe symptoms during the last phase of their lives. Palliative sedation, although one of the options of last resort, remains a much debated and controversial issue and is often referred to as a form of slow euthanasia or euthanasia in disguise.
A prospective longitudinal and descriptive design was used. Each patient admitted in one of the 8 participating units was included if they met the inclusion criteria and gave written informed consent.
266 patients were included. The incidence of palliative sedation was 7;5%. For the group of sedated patients results show that 90% entered the palliative care unit being fully conscious. Two patients were comatose upon arrival. 90% of the patients remained fully conscious up to the day palliative sedation was started. When looking at the effect of palliative sedation on the level of consciousness the analysis strongly suggest that the palliative sedation - as expected- has an impact on the GCS score. Irrespective of the dichotomization of the score the probability of having a lower GCS increases substantially once sedation is initiated. Additionally, results show that once palliative sedation is administered, the level of consciousness gradually goes down up until the day of death.
Palliative sedation is nor slow euthanasia nor an ambivalent practice. It is an intentional medical treatment which is administered in a proportional way when refractory suffering occurs. It occurs in extraordinary situations and at the very end of the dying process.
患有绝症的患者在生命的最后阶段常常面临严重症状。姑息性镇静尽管是最后的手段之一，但仍是一个备受争议的问题，常被视为一种变相的缓慢安乐死或安乐死形式。
采用前瞻性纵向描述性设计。8个参与单位中收治的每位符合纳入标准并签署书面知情同意书的患者均被纳入。
纳入266例患者。姑息性镇静的发生率为7.5%。对于接受镇静的患者组，结果显示90%进入姑息治疗病房时意识清醒。两名患者入院时昏迷。90%的患者在开始姑息性镇静前一直保持完全清醒。在观察姑息性镇静对意识水平的影响时，分析强烈表明，姑息性镇静——正如预期的那样——对格拉斯哥昏迷评分有影响。无论评分如何划分，一旦开始镇静，格拉斯哥昏迷评分降低的可能性会大幅增加。此外，结果显示，一旦实施姑息性镇静，意识水平会逐渐下降直至死亡之日。
姑息性镇静既不是缓慢安乐死，也不是模棱两可的做法。它是一种在出现难治性痛苦时按比例实施的有意的医疗治疗。它发生在特殊情况下和临终过程的最后阶段。
