Palliative sedation therapy in the last weeks of life: A literature review and recommendations for standards

Journal of Palliative Medicine

Volumn 10, Issue 1, 2007, Pages 67-85

  De Graeff, Alexander ^a   Dean, Mervyn ^b  

^a UNIVERSITY MEDICAL CENTER UTRECHT   (Netherlands)

^b Western Memorial Regional Hospital Corner Brook   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ANESTHETIC AGENT; ANTICONVULSIVE AGENT; ANXIOLYTIC AGENT; BARBITURIC ACID DERIVATIVE; BENZODIAZEPINE DERIVATIVE; HALOPERIDOL; LEVOMEPROMAZINE; LORAZEPAM; MIDAZOLAM; MUSCLE RELAXANT AGENT; NEUROLEPTIC AGENT; OPIATE DERIVATIVE; PHENOBARBITAL; PROPOFOL; SEDATIVE AGENT;

CONTINUOUS INFUSION; DRUG DOSE TITRATION; DYING; E-MAIL; EUTHANASIA; HUMAN; HYDRATION; MEDICAL DOCUMENTATION; MEDICAL ETHICS; MEDICAL EXPERT; MEDICAL LITERATURE; MEDICAL RESEARCH; MEDICAL SPECIALIST; PALLIATIVE THERAPY; REVIEW; SEDATION; SINGLE DRUG DOSE; STANDARD; SYMPTOM; SYSTEMATIC REVIEW; TREATMENT OUTCOME; UNSPECIFIED SIDE EFFECT;

EID: 33846915382     PISSN: 10966218     EISSN: None     Source Type: Journal    
DOI: 10.1089/jpm.2006.0139     Document Type: Review

References (191)

1. Roy DJ: Need they sleep before they die? J Palliat Care 1990;6:3-4.
2. Lo B, Rubenfeld G: Palliative sedation in dying patients. "We turn to it when everything else hasn't worked." JAMA 2005;294:1810-1816.
3. Fainsinger R, Miller MJ, Bruera E, et al: Symptom control during the last week of life on a palliative care unit. J Palliat Care 1991;7:5-11.
4. Fainsinger RL, Landman W, Hoskings M, Bruera E: Sedation for uncontrolled symptoms in a South African hospice. J Pain Symptom Manage 1998;16:145-152.
5. Fainsinger RL, Waller A, Bercovici M, Bengtson K, Land man W, Hosking M, Nunez-Olarte JM, deMoissac D: A multicenter international study for uncontrolled symptoms in terminally ill patients. Palliat Med 2000;14:257-265.
6. Kohara H, Ueoka H, Takeyama H: Sedation for terminally ill patients with cancer with uncontrollable physical distress. J Palliat Med 2005;8:20-25.
7. Morita T, Inoue S, Chihara S: Sedation for symptom control in Japan: The importance of intermittent use and communication with family members. J Pain Symptom Manage 1996;12:32-38.
8. Morita T: Differences in physician-reported practice in palliative sedation therapy. Support Care Cancer 2004;12:584-592.
9. Morita T, Chinone Y, Ikenaga M, Miyoshi M, Nakaho T, Nishitateno K, Sakonji M, Shima Y, Suenaga K, Takigawa C, Kohara H, Tani K, Kawamura Y, Matsubara T, Watanabe A, Yagi Y, Sasaki T, Higuchi A, Kimura H, Abo H, Ozawa T, Kizawa Y, Uchitomi Y; Japan Pain, Palliative Medicine, Rehabilitation, and Psycho-Oncology Study Group: Ethical validity of palliative sedation therapy: a multi-center, prospective, observational study conducted on specialist palliative care units in Japan. J Pain Symptom Manage 2005;30:308-319.
10. Müller-Busch HC, Andres l, Jehser T: Sedation in palliative care - A critical analysis of 7 years experience. BMC Palliat Care 2003;2:2.
11. Peruselli C, Di Giulio P, Toscani F, Gallucci M, Brunelli C, Costantini M, Tamburini M, Paci E, Miccinesi G, Addington-Hall JM, Higginson IJ: Home palliative care for terminal cancer patients: A survey on the final week of life. Palliat Med 1999;13:233-241.
12. Stone P, Phillips C, Spruyt O, Waight C: A comparison of the use of sedatives in a hospital support team and in a hospice. Palliat Med 1997;11:140-144.
13. Sykes N, Thorns A: Sedative use in the last week of life and the implications for end-of-life decision making. Arch Internal Med 2003;163:341-344.
14. Ventafridda V, Ripamonti C, De Conno P, Tamburini M, Cassileth BR: Symptom prevalence and control during cancer patients' last days of life. J Palliat Care 1990;6:7-11.
15. Miccinesi G, Rietjens JAC, Deliens L, Paci E, Bosshard G, Nilstun T, Norup M, van der Wal G; on behalf of the EURELD Consortium: Continuous deep sedation: Physicians' experiences in six European countries. J Pain Symptom Manage 2006:31:122-129.
16. Rietjens JAC, van der Heide A, Vrakking AM, Onwuteaka-Philipsen BD, van der Maas PJ, van der Wal G: Physician reports of terminal sedation without hydration or nutrition for patients nearing death in the Netherlands. Ann Intern Med 2004;141:178-185.
17. Broeckaert B: Palliative sedation: ethical aspects. In: Gastmans C (ed): Between Technology and Humanity. The Impact of Technology on Health Care Ethics. Leuven; Lenven University Press, 2002, pp. 239-255
18. Cherny NI: Sedation in response to refractory existential distress: Walking the fine line. J Pain Symptom Manage 1998; 16:404-406.
19. Levy MH, Cohen SD: Sedation for the relief of refractory symptoms in the imminently dying: a fine intentional line. Semin Oncol 2005;32:237-246.
20. Loewy EH: Terminal sedation, self-starvation, and orchestrating the end of life. Arch Intern Med 2001;161:329-332.
21. Quill TE, Lo B, Brock DW: Palliative options of last resort: A comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide and voluntary active euthanasia. JAMA 1997;278:2099-2104.
22. Quill TE, Byock IR: Responding to intractable terminal suffering: The role of terminal sedation and voluntary refusal of food and fluids. Ann Intern Med 2000;132:408-414.
23. Rousseau P: The ethical validity and clinical experience of palliative sedation. Mayo Clin Proc 2000;75:1064-1069.
24. Billings JA, Block SD: Slow euthanasia. J Palliat Care 1996;12:21-30.
25. Brody H: Commentary on Billings and Block's "Slow euthanasia." J Palliat Care 1996;12:38-41.
26. Mount BM: Morphine drips, terminal sedation, and slow euthanasia: definitions and facts, not anecdotes. J Palliat Care 1996;12:31-37.
27. Braun TC, Hagen NA, Clark T: Development of a clinical practice guideline for palliative sedation. J Palliat Med 2003;6:345-330.
28. Cherny NI, Portenov RK: Sedation in the management of refractory symptoms: guidelines for evaluation and treatment. J Palliat Care 1994;10:31-38.
29. Cherny NI: Sedation: Uses, abuses and ethics at the end of life. Jerusalem, Israel: Shaare Zeclek Medical Centre, 2003.
30. Cowan JD, Palmer TW: Practical guide to palliative sedation. Curr Oncol Rep 2002;4:242-249.
31. Hawryluck LA, Harvey WRC, Lernieux-Charles L, Singer PA: Consensus guidelines on analgesia and sedation in dying intensive care unit patients. BMC Med Ethics 2002;3:3.
32. Morita T, Bito S, Kurihara Y, Uchitomi Y: Development of a clinical guideline for palliative sedation therapy using the Delphi method. J Palliat Med 2005;8:716-729.
33. Rousseau P, Ross E: Use of palliative sedation. Carl T. Hayden VA Medical Center, Phoenix, Arizona, 2000.
34. Rousseau P: Existential suffering and palliative sedation: A brief commentary with a proposal for clinical guidelines. Am J Hosp Palliat Care 2001;18:151-153.
35. Royal Dutch Medical Association: National Guideline for Palliative Sedation. Utrecht, The Netherlands: Royal Dutch Medical Association, 2005.
36. Schuman ZD, Lynch M, Abrahm JL: Implementing institutional change: an institutional case study of palliative sedation. J Palliat Med 2005;8:666-676.
37. Wein S: Sedation in the imminently dying patient. Oncology 2000;14:585-591.
38. Center for Evidence Based Medicine: Levels of Evidence and grades of recommendation. 〈www.cebm.net/levels_of_evidence.asp〉 (Last accessed October 21, 2006).
39. Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Vigano A, Larkin P, De Cormo F, Hanks G, Kaasa S; Steering Committee of the European Association for Palliative Care: Prognostic factors in advanced cancer patients: evidence-based clinical recommendations - A study by the steering committee of the European Association for Palliative Care. J Clin Oncol 2005;23:6240-6248.
40. Porta-Sales J: Sedation and terminal care. Eur J Palliat Care 2001;8:97-100.
41. Chater S, Viola R, Paterson J, Jarvis V: Sedation for intractable distress in the dying - a survey of experts. Palliat Med 1998;12:255-269.
42. Cowan JD, Walsh D: Terminal sedation in palliative medicine - Definition and review of the literature. Support Care Cancer 2001;9:403-407.
43. Krakauer EL, Penson RT, Truog RD, King LA, Chabner BA, Lynch TJ Jr: Sedation for intractable distress of a dying patient: Acute palliative care and the principle of double effect. Oncologist 2000;5:53-62.
44. Furst CJ, Hagenfeldt K: End-of-life sedation - Definition and clinical guidelines needed. Lakartidningen 2002;99:3830-3835.
45. Goldstein-Shirley J Fine PC: Ethics of total sedation, total sedation educational resources draft, prepared by a Task Force of the NHPCO Ethics Committee (Session 8A, March 25, 2001), pp. 3-8.
46. Salacz ME, Weissman DE; Controlled sedation for refractory suffering: part I. J Palliat Med 2005;8:136-138.
47. Taylor BR, McCann RM: Controlled sedation for physical and existential suffering? J Palliat Med 2005;8:144-147.
48. Broeckaert B, Nunez Olarte JM: Sedation in palliative care: Facts and concepts. In: Ten Have H, Clark D (eds): The Ethics of Palliative Care: European Perspectives. Buckingham: Open University Press, 2002, pp. 166-180.
49. Heel A, McClement SE, Harlos M: Palliative sedation therapy: a review of definitions and usage. Int J Palliat Nurs 2002;8:190-199.
50. Morita T, Tsuneto S, Shima Y: Proposed definitions for terminal sedation. Lancet 2001;358:335-336.
51. Morita T, Tsuneto S, Shima Y: Definition of sedation for symptom relief: A systematic literature review and a proposal of operational criteria. J Pain Symptom Manage 2002;24:447-453.
52. Materstvedt LJ, Clark D, Ellershaw J, Forde R, Gravgaard AM, Muller-Busch HC, Porta i Sales J, Rapin CH; EAPC Ethics Task Force: Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force. Palliat Med 2003;17:97-101.
53. Jackson WC: Palliative sedation vs terminal sedation: what's in a name? Am J Hosp Palliat Care 2002;19:81-82.
54. Jansen LA, Sulmasy DP: Sedation, alimentation, hydration, and equivocation: careful conversation about care at the end of life. Ann Intern Med 2002;136:845-849.
55. Morita T, Tsunoda J, Inoue S, Chihara S: Terminal sedation for existential distress. Am J Hosp Palliat Care 2000;17:189-195.
56. Sykes N, Thorns A: The use of opioids and sedatives at the end of life. Lancet Oncol 2003;4:312-318.
57. Barreth A, Fainsinger RL, Oneschuk D, Pritchard Z: The challenging of communicating intent of sedation in advanced illness. J Palliat Care 2003;19:217-219.
58. Brajtman S: The impact on the family of terminal restlessness and its management. Palliat Med 2003;17:454-460.
59. Blondeau D, Roy L, Dumont S, Godin G, Martineau I: Physicians' and pharmacists' attitudes toward the use of sedation at the end of life: Influence of prognosis and type of suffering. J Palliat Care 2005;21:238-245.
60. Coyle N, Adelhardt J, Foley K, Portenoy RK: Character of terminal illness in the advanced cancer patient: pain and other symptoms during the last four weeks of life. J Pain Symptom Manage 1990;5:83-93.
61. Morita T, Akechi T, Sugawara Y, Chihara S, Uchitomi Y: Practices and attitudes of Japanese oncologists and palliative care physicians concerning terminal sedation: A nationwide survey. J Clin Oncol 2002;20:758-764.
62. Eckerdal C: Sedation in palliative care - The doctor's perspective. In: Tannsjo T (cd): Terminal Sedation: Euthanasia in Disguise? Dordrecht: Kluwer Academic Publishers, 2004, pp. 37-41.
63. Werth JL, Jr: Philosophical Principles of Ethical Judgments. Living with Grief: Ethical Dilemmas and End-of-Life Care. Miami Beach, FL: Hospice Foundation of America, 2005, pp. 1-14.
64. Rosen EJ: A case of "terminal sedation" in the family. J Pain Symptom Manage 1998;16:406-407.
65. Morita T, Ikenaga M, Adachi I, Narabayashi I, Kizawa Y, Honke Y, Kohara H, Mukaiyama T, Akechi T, Uchitomi Y; Japan Pain, Rehabilitation, Palliative Medicine, and Psycho-Oncology Study Group.et al: Family experience with palliative sedation therapy for terminally ill cancer patients. J Pain Symptom Manage 2004;28:557-565.
66. Rousseau P: Existential distress and palliative sedation. Anesth Analg 2005;101:611-612.
67. Elger BS, Chevrolet JC: Attitudes of health care workers towards waking a terminally ill patient in the intensive care unit for treatment decisions. Intensive Care Med 2003;229:487-490.
68. Kaldjian LC, Jekel JF, Bernene JL, Rosenthal GE, Vaughan-Sarrazin M, Duffy TP: Internists' attitudes towards terminal sedation in end of life care. J Med Ethics 2004;30:499-503.
69. Monta T, Hirai K, Akechi T, Uchitomi Y: Similarity and difference among standard medical care, palliative sedation therapy and euthanasia: A multidimensional scaling analysis on physicians and the general populations' opinions. J Pain Symptom Manage 2003;25:357-362.
70. Sales JP: Sedation and terminal care. Eur J Palliat Care 2001;8:97-100.
71. rd ed. Oxford: Oxford University Press, 2004, pp. 84-97.
72. Cloth FM 3rd, Schwartz J: Developing a physicians' palliative care pain hotline in Maryland. Am J Hosp Palliat Care 2000;17:24-28.
73. Lloyd-Williams M, Rashid A: An analysis of calls to an out-of-hours palliative care advice line. Public Health 2003;117:125-127.
74. Wenk R, Alegre C, Diaz C: Palliative care hotline in Argentina. J Pain Symptom Manage 1993;8:123-124.
75. Bottomley DM, Hanks CW: Subcutaneous midazolam infusion in palliative care. J Pain Symptom Manage 1990;5:259-261.
76. Burke AL, Diamond PL, Hulbert J, Yeatman I, Parr EA: Terminal restlessness - Its management and the role of midazolam. Medical J Aust 1991;155:485-487.
77. Cameron D, Bridge D, Blitz-Lindeque J: Use of sedation to relieve refractory symptoms in dying patients. S Afr Med J 2004;94:445-449.
78. Chiu TY, Hu WY, Lue BH, Cheng SY, Chen CY: Sedation for refractory symptoms of terminal cancer patients in Taiwan. J Pain Symptom Manage 2001;21:467-472.
79. Fainsinger RL: Use of sedation by a hospital care support team. J Palliat Care 1998;14:51-54.
80. Fainsinger RL, de Moissac D, Mancini I, Oneschuk D: Sedation for delirium and other symptoms in terminally ill patiens in Edmonton. J Palliat Care 2000;16:5-10.
81. Greene WR, Davis WH: Titrated intravenous barbiturates in the control of symptoms in patients with terminal cancer. South Med J 1991;84:332-337.
82. McIver B, Walsh D, Nelson K: The use of chlorpromazine for symptom control in dying cancer patients. J Pain Symptom Manage 1994;9:341-345.
83. McNamara P, Minton M, Twycross RC: Use of midazolam in palliative care. Palliat Med 1991;5:244-249.
84. Morita T, Tsunoda J, Inoue S, Chihara S: Do hospice clinicians sedate patients intending to hasten death? J Palliat Care 1999;15:20-23.
85. Morita T, Chinone Y, Ikenaga M, Miyoshi M, Nakaho T, Nishitateno K, Sakonji M, Shima Y, Suenaga K, Takigawa C, Kohara H, Tani K, Kawamura Y, Matsubara T, Watanabe A, Yagi Y, Sasaki T, Higuchi A, Kimura H, Abo H, Ozawa T, Kizawa Y, Uchitomi Y; Japan Pain, Palliative Medicine, Rehabilitation, and Psycho-Oncology Study Croup: Efficacy and safety of palliative sedation therapy: A multicenter, prospective, observational study conducted on specialist palliative care units in Japan. J Pain Symptom Manage 2005;30:320-328.
86. Soares LGL, Naylor C, Martins MA, Peixoto G: Dexmedetomidine: A new option for intractable distress in the dying. J Pain Symptom Manage 2002;24:6-8.
87. Stiefel F, Fainsinger R, Bruera E: Acute confusional states in patients with advanced cancer J Pain Symptom Manage 1992;7:94-98.
88. Davis MP, Ford PA: Palliative sedation definition, practice, outcomes and ethics. J Palliat Med 2005;8:699-701.
89. Morita T: Palliative sedation to relieve psycho-existential suffering of terminally ill cancer patients. J Pain Symptom Manage 2004;28:445-450.
90. Nunez Olarte JM, Guillen DG: Cultural issues and ethical dilemmas in palliative and end-of-life care in Spain. Cancer Control 2001;8:46-54.
91. Rousseau P: Existential suffering and palliative sedation in terminal illness. Prog Palliat Care 2002;10:222-224.
92. Shaiova L: Case presentation: Terminal sedation and existential distress. J Pain Symptom Manage 1998;16:403-404.
93. Bruera E, Watanabe S: New developments in the assessment of pain in cancer patients. J Pain Symptom Manage 1994;2:312-318.
94. Robinson K, Bruera E: The management of pain in patients with advanced cancer: The importance of multidimensional assessments. J Palliat Care 1995;11:51-53.
95. Zaza C, Baine N: Cancer pain and psychosocial factors: a critical review of the literature. J Pain Symptom Manage 2002;24:526-542.
96. Clark D: 'Total pain,' disciplinary power and the body in the work of Cecily Saunders, 1958-1967. Soc Sci Med 1999;49:727-736.
97. Vitetta L, Kenner D, Sali A: Sedation and analgesia-prescribing patterns in erminally ill patients at the end of life. Am J Hosp Palliat Care 2005;22:465-473.
98. Morita T, Miyashita M, Kimura R, et al: Emotional burden of nurses in palliative sedation therapy. Palliat Med 18:550-557, 2004.
99. Morita T, Hirai K, Okazaki Y: Preferences for palliative sedation therapy in the Japanese general population. J Palliat Med 2002;5:375-385.
100. Morita T, Ikenaga M, Adachi I, et al: Concerns of family members of patients receiving palliative sedation therapy. Supp Care Cancer 2004;12:885-889.
101. rd ed). Oxford, Oxford University Press, 2004, pp 587-618
102. Lanuke K, Fainsinger RL, DeMoissac D, Adachi I, Shima Y: Two remarkable dyspneic men: When should terminal sedation be administered? J Palliat Med 2003;6:277-281.
103. Morita T, Tsunoda J, Inoue S, Chihara S: The decision-making process in sedation for symptom control in Japan. Palliat Med 1999;13:262-264.
104. Rousseau PC: Palliative sedation. Am J Hosp Palliat Care 2002;19:295-297.
105. nd ed. London: BMA, 2004
106. Friedlander MM, Brayman Y, Breitbart WS: Delirium in palliative care. Oncology 2004;18:1541-1553.
107. Gatellari M, Butow PN, Tattersall MHN: Sharing decisions in cancer care. Soc Sci Med 2001;52:1865-1878.
108. rd ed. Oxford: Oxford University Press, 2004, pp. 61-65.
109. Say RE, Thomson R: The importance of patient preferences in treatment decisions - challenges for doctors. BMJ 2003;2327:542-545.
110. Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA: Factors considered important at the end of life by patients, family, physicians and other care providers. JAMA 2000;284:2476-2482.
111. Stiggelbout AM, Molewijk AC, Often W, Timmermans DR, van Bockel JH, Kievit J: Ideals of patient autonomy in clinical decision making: a study on the development of a scale to assess patients' and physicians' view. J Med Ethics 2004;30: 268-274.
112. Tschann JM, Kaufman SR, Micco GP: Family involvement in end of life hospital care. J Am Geriatrics Sc 2003;51:835-840.
113. Weissman DE: Decision making at a time of crisis near the end of life. JAMA 2004;292:1738-1743.
114. nd ed. New York: Palgrave, 2002.
115. Fainsinger RL, Nunez-Olarte JM, DeMoissac DM: The cultural differences in perceived value of disclosure and cognition: Spain and Canada. J Palliat Care 2003;19:43-48.
116. Purnell LD, Paulanka BJ: Transcultural Health Care: A Culturally Competent Approach. Philadelphia: FA Davis Co, 1998.
117. Hoffman JC, Wenger NS, Davis RB, Teno J, Connors AF Jr, Desbiens N, Lynn J, Phillips RS: Patient preferences for communication with physicians about end-of-life decisions. Ann Intern Med 1997;127:1-12.
118. Maddocks I: Teaching palliative care in East Asia. Palliat Med 2000;14:535-537.
119. Fukui S, Kawagoe H, Masako S, Noriko N, Hiroko N, Toshie M: Determinants of the place of death among terminally ill cancer patients under home hospice care in Japan. Palliat Med 2003;17:445-453.
120. Hinkka H, Kosunen E, Lammi EK, Metsanoja R, Puustelli A, Kellokumpu-Lehtinen P: Decision-making in terminal care: a survey of Finnish doctors' treatment decisions in end-of-life scenarios involving a terminal cancer and a terminal dementia patient. Palliat Med 2002;16:195-204.
121. Agrawal M, Emanuel EJ: Death and dignity: Dogma disputed. Lancet 2002;360:1997-1998.
122. Street AF, Kissane DW: Constructions of dignity in end-of-life care. J Palliat Care 2001;17:93-101.
123. Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M: Dignity in the terminally ill: A cross-sectional, cohort study. Lancet 2002;360:2026-2030.
124. Turner K, Chye R, Agarwal G, Philip J: Dignity in dying: A preliminary study of patients in the last three days of life. J Palliat Care 1996;12:7-13.
125. Batchelor A, Jenal L, Kapadia F, Streat S, Whetstine L, Woodcock B: Ethics roundtable debate: Should a sedated dying patient be awakened to say goodbye to family? Crit Care 2003;7:335-338.
126. Morita T, Tsunoda J, lnoue S, Chihara S: Effects of high dose opioids and sedatives on survival in terminally ill cancer patients. J Pain Symptom Manage 2001;21:282-289.
127. Amesbury BDW, Dunphy KP: The use of subcutaneous midazolam in the home care setting. Palliat Med 1989;3:299-301.
128. De Sousa E, Jepson BA: Midazolam in terminal care. Lancet 1998;1:67-68.
129. Gremaud G, Zulian G: Indications and limitations of intravenous and subcutaneous midazolam in palliative care center. J Pain Symptom Manage 1998;15:331-333.
130. Holdsworth MT, Adams VR, Chavez CM, Vaughan LJ, Duncan MH: Continuous midazolam infusion for the management of morphine induced myoclonus. Ann Pharmacother 1995;29:25-29.
131. Mercadante S, DeConno F, Ripamonti C: Propofol in terminal care. J Pain Symptom Manage 1995;10:639-642.
132. Morita T, Tei Y, Inoue S: Correlation of the dose of midazolam for symptom control with administration periods: the possibility of tolerance. J Pain Symptom Manage 2003;25:269-375.
133. Moyle J: The use of propofol in palliative medicine. J Pain Symptom Manage 1995;10:643-646.
134. Lundström S, Zachrisson U, Fürst CJ: When nothing helps: propofol as sedative and antiemetic in palliative cancer care. J Pain Symptom Manage 2005;30:570-577.
135. Ramani S, Kamad AB: Long-term subcutaneous infusion of midazolam for refractory delirium in terminal breast cancer. South Med J 1996;89:1101-1103.
136. Stirling LC, Kurowska A, Tookman A: The use of phenobarbitone in the management of agitation and seizures at the end of life. J Pain Symptom Manage 1999;17:363-368.
137. Truog RD, Berde CB, Mitchell C, Grier HE: Barbiturates in the care of the terminally ill. N Engl J Med 1992;327:1678-1681, 1992
138. Cheng C, Roemer-Becuwe C, Pereira J: When midazolam fails. J Pain Symptom Manage 2002;23:256-265.
139. Viola RA, Wells GA, Petersen J: The effects of fluid status and fluid therapy on the dying: a systemic review. J Palliat Care 1007;13:41-52.
140. Koshuta MA, Schmitz PJ, Lynn J: Development of an institutional policy on artificial hydration and nutrition. Kennedy Inst Ethics J 1991;1:133-139.
141. Billings JA: Comfort measures for the terminally ill. Is dehydration painful? J Am Geriat Soc 1985;33:808-810.
142. Craig GM: On withholding nutrition and hydration in the terminally ill: Has palliative medicine gone too far? J Med Ethics 1994;20:139-143.
143. Cranford RE: Neurologic syndromes and prolonged survival: when can artificial nutrition and hydration be forgone? Law Med Health Care 1991;19:13-22.
144. Dunlop RJ, Ellershaw JE, Baines MJ, Sykes N, Saunders CM: On withholding nutrition and hydration in the terminally ill: Has palliative medicine gone too far? A reply. J Med Ethics 1995;21:141-143.
145. Dunphy K, Finlay I, Rathbone C, Gilbert J, Hicks F: Rehydration in palliative and terminal care: if not - Why not? Palliat Med 1995;9:221-228.
146. Fainsinger R, Bruera E: The management of dehydration in terminally ill patients. J Palliat Care 1994;10:55-59.
147. Ganzini L, Goy ER, Miller LL, Harvath TA, Jackson A, Delorit MA: Nurses experience with hospice patients who refuse food and fluids to hasten death. N Engl J Med 2003;349:359-366.
148. Meares CJ: Nutritional issues in palliative care. Semin Oncol Nurs 2000;16:135-145.
149. Morita T, Hyodo I, Yoshimi T, Ikenaga M, Tamura Y, Yoshizawa A, Shimada A, Akechi T, Miyashita M, Adachi I; Japan Palliative Oncology Study Group: Association between hydration volume and symptoms in terminally ill cancer patients with abdominal malignancies. Ann Oncol 2005;16:640-647.
150. National Council for Hospice and Specialist Palliative Care Services: Artificial hydration for people who are terminally ill. Eur J Palliat Care 1997;4:29.
151. Printz LA: Is withholding hydration a valid comfort measure in the terminally ill? Geriatrics 1988;43:84-88.
152. Burge FI: Dehydration symptoms of palliative care cancer patients. J Pain Symptom Manage 1993;8:454-464.
153. Cerchietti L, Navigante A, Sauri A, Susil RC, Taylor RH, Kavoussi LR, Anderson JH, Sakuma I, Dohi T, Stoianovici D: Hypodermoclysis for control of dehydration in terminal-stage cancer. Int J Palliat Nurs 2001;6:370-374.
154. Ellershaw JE, Sutcliffe JM, Saunders CM: Dehydration and the dying patient. J Pain Symptom Manage 1995;10:192-197.
155. McCann RM, Hall WJ, Groth-Juncker A: Comfort care for terminally ill patients: The appropriate use of nutrition and hydration. JAMA 1994;272:1263-1266.
156. Musgrave CF, Bartal N, Opstad J: The sensation of thirst in dying patients receiving IV hydration. J Palliat Care 1995;11:17-21.
157. Bruera E, Franco J, Maltoni M, Watanabe S, Suarez-Almazor M: Changing pattern of agitated delirium in patients with advanced cancer: association with cognitive monitoring, hydration and opiate rotation. J Palliat Care 1995;10:287-291.
158. Lawler PC, Cagnon B, Mancini IL, Pereira JL, Hanson J, Suarez-Almazor ME, Bruera ED: Occurrence, causes and outcome of delirium in patients with advanced cancer. A prospective study. Arch Intern Med 2000;160:786-794.
159. Bruera E, Sala R, Rico MA, Moyano J, Centeno C, Willey J, Palmer JL: Effects of parenteral hydration in terminally ill cancer patients: A preliminary study. J Clin Oncol 2005;23:2366-2371.
160. Ashby, M, Stoffell B: Artificial hydration and alimentation at the end of life: A reply to Craig. J Med Ethics 1995;21:135-140.
161. Gillon K: Palliative care ethics: non-provision of artificial nutrition and hydration to terminally ill sedated patients. J Med Ethics 1994;20:31-132.
162. Chiu TY, Hu WY, Cheng SY, Chen CY: Ethical dilemmas in palliative care: A study in Taiwan. J Med Ethics 2000;26:353-357.
163. Wanzer SH, Federman DD, Adelstein SJ, Cassel CK, Cassem EH, Cranford RE, Hook EW, Lo B, Moertel CC, Safar P: The physician's responsibility toward hopelessly ill patients. A second look. N Engl J Med 1989;320:844-849.
164. American Medical Association: Good care of the dying patient. Council on Scientific Affairs, American Medical Association. JAMA 1996;275:474-478.
165. American Geriatrics Society: The care of dying patients: A position statement from the American Geriatrics Society. AGS Ethics Committee. J Am Geriatr Soc 1995;43:577-578.
166. Burt RA: The Supreme Court speaks - Not assisted suicide but a constitutional right to palliative care. N Engl J Med 1997;337:1234-1236.
167. Scanlon C, Fleming C: Ethical issues in caring for the patient with advanced cancer. Nurs Clin North Am 1969;24:977-986.
168. Fins JJ, Bacchetta MD, Miller FG: Clinical pragmatism: A method of moral problem solving. Kennedy Inst Ethics J 1997;7:129-145.
169. Miller FG, Fins JJ, Bacchetta MD: Clinical pragmatism: John Dewey and clinical ethics. J Contemp Health Law Policy 1996;13:27-51.
170. Kuhse H, Singer P, Baume P, Clark M, Rickard M: End-of-life decisions in Australian medical practice. Med J Aust 1997;166:191-196.
171. Meier DE, Emmons CA, Wallenstein S, Quill T, Morrison RS, Cassel CK: A national survey of physician-assisted suicide and euthanasia in the United States. N Engl J Med 1998;338:1193-1201.
172. Stevens CA, Hassan R: Management of death, dying and euthanasia: Attitudes and practices of medical practitioners in South Australia. Arch Intern Med 1994;154:575-584.
173. Van der Heide A, Deliens L, Faist K, Nilstun T, Norup M, Paci E, van der Wal G, van der Maas PJ; EURELD consortium: End-of-life decision-making in six European countries. Lancet 2003;362:345-350.
174. Willems DL, Daniels ER, van der Wal G, van der Maas PJ, Emanuel EJ: Attitudes and practices concerning the end of life: a comparison between physicians from the United States and from The Netherlands. Arch Intern Med 2000;160:63-68.
175. Brock DW: Physician-assisted suicide as a last resort option at the end of life. In: Quill TE, Battin MP (eds): Physician-Assisted Dying: The Case for Palliative Care and Patient Choice. Baltimore: Johns Hopkins University Press, 2004, p. 130-150.
176. Craig G: Is sedation without hydration or nourishment in terminal care lawful? Med Leg J 1994;62:198-201.
177. Craig GM: On withholding artificial hydration and nutrition from terminally ill sedated patients. The debate continues. J Med Ethics 1996;22:147-153.
178. Orentlicher D: The Supreme Court and physician-assisted suicide - Rejecting assisted suicide but embracing euthanasia. N Engl J Med 1997;337:1236-1239.
179. Brody H: Causing, intending, and assisting death. J Clin Ethics 1993;4:112-117.
180. Quill TE, Dresser R, Brock DW: The rule of double effect - A critique of its role in end-of-life decision making. N Engl J Med 1997;337:1768-1671.
181. Morita T, Tei Y, Inoue S: Ethical validity of palliative sedation therapy. J Pain Symptom Manage 2003;25:103-105.
182. Waller A, Bercovitch M, Fainsinger R, Adunsky A: Symptom control and the need for sedation during the treatment in Tel Hashomer In-Patients Hospice. Book of abstracts, 6th Congress of the European Association for Palliative Care, Geneva, Switzerland, 2000, p. 21.
183. Bell GD, McCloy RF, Charlton JE, Campbell D, Dent NA, Gear MW, Logan RF, Swan CH: Recommendations for standards of sedation and patient monitoring during gastrointestinal endoscopy. Gut 1991;32:823-827.
184. Devlin JW, Fraser GL, Kanji S, Riker RR: Sedation assessment in critically ill adults. Ann Pharmacother 2001;35:1624-1632.
185. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K: The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. J Palliat Care 1991;7:6-9.
186. Morita T, Tsunoda J, Inoue S, Chihara S, Oka K: Communication Capacity Scale and Agitation Distress Scale to measure the severity of delirium in terminally ill cancer patients: a validation study. J Pain Symptom Manage 2001;15:197-206.
187. Ramsay MAE, Savege TM, Simpson BRJ, Goodwin R: Controlled sedation with alpaxalone-alphadolone. Br Med J 1974;2:656-659.
188. Teasdale G, Jennett B: Assessment of impaired consciousness and coma. Lancet 1974;2:81-84.
189. Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR: Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003;289:2983-2991.
190. Riker RR, Picard JT, Fraser GL: Prospective evaluation of the Sedation-agitation Scale for adult critically ill patients. Crit Care Med 1999;27:1325-1329.
191. Devlin JW, Boleski G, Mlynarek M, Nerenz DR, Peterson E, Jankowski M, Horst HM, Zarowitz BJ: Motor Activity Assessment Scale: A valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med 1999;27:1271-1275.