Proposal for a decision-making and caring process for palliative sedation

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Published: Apr 9, 2021
Keywords:
palliative care, palliative sedation, decision-making process, clinical ethics, informed consent, advance care planning

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Massimiliano Carassiti, Dr.
Bio-Medical Campus of Rome
Anna De Benedictis, Enf.
Bio-Medical Campus of Rome
Nunziata Comoretto, Dr.
Bio-Medical Campus of Rome
Bruno Vincenzi, Dr.
Bio-Medical Campus of Rome
Vittoradolfo Tambone, Dr.
Bio-Medical Campus of Rome

Abstract




Background: Despite a general ethical basis for justification, pa- lliative sedation (PS) still has many controversial aspects that re- quire further discussion and clarification. From a practical stan- dpoint, moreover, there is considerable variability in the clinical procedure and an increasingly uncertain boundary between PS and involuntary euthanasia. This situation makes it necessary to 





develop local guidelines to clarify the procedures and the ethical implications of PS.


Purpose: The aim of this paper is to present the main features of the ethical and clinical decision-making process for PS develo- ped at the University Hospital «Campus Bio-Medico», in Rome.


Methods: The development of the present proposal was prece- ded by a survey, through a questionnaire, on the knowledge of medical and nursing staff on PS, and a retrospective study on me- dical records, to see how PS is used inside the hospital.


Results: The benefit of this decision-making process is that it considers the pharmacological aspects, but also clearly addres- ses the ethical and legal procedure of PS, communication, the care for family members and health workers, the possibility of ta- king advantage of a clinical ethics consultation in complex cases or where it is difficult to reach a joint decision. We also emphasize that the application of the decision-making process must be su- pported by training sessions and active confrontation, to promote proper understanding and correct use of the guidelines themsel- ves, but also to ensure respect for the conscience of health care professionals who are involved in the procedures of PS.


Conclusions: It is recommended that all health care institutions produce local guidelines for PS, attentive to scientific standards, but also sensitive to the ethical and cultural context in which they are used. Ethical and clinical guidelines provide not only a well-struc- tured operational guidance and training for clinical work, but are also a necessary tool for transparency with regard to all society.







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How to Cite
Carassiti, M., De Benedictis, A., Comoretto, N., Vincenzi, B., & Tambone, V. (2021). Proposal for a decision-making and caring process for palliative sedation. Medicina Y Ética, 25(1), 145–168. Retrieved from https://revistas.anahuac.mx/index.php/bioetica/article/view/702
Issue
Vol. 25 No. 1 (2014): Medicina y Ética Vol. XXV No.1
Section
Articles

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Author Biographies

Massimiliano Carassiti, Dr., Bio-Medical Campus of Rome

Associate Professor of Anesthesiology

Anna De Benedictis, Enf., Bio-Medical Campus of Rome

Nursing Directorate

Nunziata Comoretto, Dr., Bio-Medical Campus of Rome

Doctor of Research in Bioethics, Institute of Philosophy of Scientific and Technological Acting (FAST)

Bruno Vincenzi, Dr., Bio-Medical Campus of Rome

Researcher in Medical Oncology, Institute of Oncology.

Vittoradolfo Tambone, Dr., Bio-Medical Campus of Rome

Associate Professor of Legal Medicine, Director of Fast, University "Campus Bio-Medico", Rome

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