Twycross Robert
Palliat Care. 2019 Jan 27;12:1178224218823511. doi: 10.1177/1178224218823511. eCollection 2019.
'Palliation sedation' is a widely used term to describe the intentional administration of sedatives to reduce a dying person's consciousness to relieve intolerable suffering from refractory symptoms. Research studies generally focus on either 'continuous sedation until death' or 'continuous deep sedation'. It is not always clear whether instances of secondary sedation (i.e. caused by specific symptom management) have been excluded. Continuous deep sedation is controversial because it ends a person's 'biographical life' (the ability to interact meaningfully with other people) and shortens 'biological life'. Ethically, continuous deep sedation is an exceptional last resort measure. Studies suggest that continuous deep sedation has become 'normalized' in some countries and some palliative care services. Of concern is the dissonance between guidelines and practice. At the extreme, there are reports of continuous deep sedation which are best described as non-voluntary (unrequested) euthanasia. Other major concerns relate to its use for solely non-physical (existential) reasons, the under-diagnosis of delirium and its mistreatment, and not appreciating that unresponsiveness is not the same as unconsciousness (unawareness). Ideally, a multiprofessional palliative care team should be involved before proceeding to continuous deep sedation. Good palliative care greatly reduces the need for continuous deep sedation.
“姑息性镇静”是一个广泛使用的术语，用于描述有意给予镇静剂以降低濒死患者的意识，从而缓解因难治性症状而产生的无法忍受的痛苦。研究通常聚焦于“持续镇静直至死亡”或“持续深度镇静”。目前尚不清楚继发性镇静（即由特定症状管理导致的镇静）的情况是否已被排除。持续深度镇静存在争议，因为它终结了一个人的“传记性生命”（与他人进行有意义互动的能力）并缩短了“生物性生命”。从伦理上讲，持续深度镇静是一种特殊的最后手段。研究表明，持续深度镇静在一些国家和一些姑息治疗服务中已变得“常态化”。令人担忧的是指南与实践之间的脱节。极端情况下，有关于持续深度镇静的报道，最好将其描述为非自愿（未经请求）安乐死。其他主要担忧涉及其仅用于非身体（存在性）原因、谵妄的诊断不足及其不当治疗，以及没有认识到无反应性与无意识（无觉知）并不相同。理想情况下，在进行持续深度镇静之前，应让多专业姑息治疗团队参与。良好的姑息治疗可大大减少持续深度镇静的需求。
