End of life care sedation for children

Current Opinion in Supportive and Palliative Care

Volumn 5, Issue 3, 2011, Pages 285-290

  Kiman, Rut ^a,b,c   Wuiloud, Alina Conti ^d   Requena, Maria Laura ^a  

^a HOSPITAL NACIONAL PROFESOR ALEJANDRO POSADAS   (Argentina)

^b UNIVERSIDAD DE BUENOS AIRES   (Argentina)

^c Bonpland CABA ^*  (Argentina)

^d Pediatric Palliative Care Fellow   (Argentina)

Author keywords

Children; End of life care; Palliative care; Sedation

Indexed keywords

AGE; CHILD; CHILD WELFARE; CONSCIOUS SEDATION; CULTURAL ANTHROPOLOGY; DECISION MAKING; ETHICS; HUMAN; METHODOLOGY; PALLIATIVE THERAPY; PRACTICE GUIDELINE; PSYCHOLOGICAL ASPECT; QUALITY OF LIFE; REVIEW; RISK FACTOR; TERMINAL CARE;

AGE FACTORS; CHILD; CHILD WELFARE; CONSCIOUS SEDATION; CULTURE; DECISION MAKING; HUMANS; PALLIATIVE CARE; PRACTICE GUIDELINES AS TOPIC; QUALITY OF LIFE; RISK FACTORS; TERMINAL CARE;

EID: 80052734864     PISSN: 17514258     EISSN: 17514266     Source Type: Journal    
DOI: 10.1097/SPC.0b013e3283492aba     Document Type: Review

References (27)

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2. Cherny NI, Radbruch L, The board of the European association for palliative care. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 2009; 23:581-593.
3. Berger J. 'Rethinking Guidelines for the Use of Palliative Sedation, ' Hastings Center Report 40, no. 3;2010: 32-38. This article delves into the problem of palliative sedation (PS) considering that a cogent medical and ethical rationale had not been articulated and offers revised guidelines for its use.
4. Medical guidelines SECPAL (2007). http://www.secpal.com/guias [Accessed 12 February 2011]. In an attempt to shed light on this debate, SECPAL provided an interesting clarification of the concepts. Commenting on the ambiguity of the use of the expression 'terminal sedation' in the medical literature, various definitions that have been used during the past years are analyzed.
5. Pousset G, Bilsen J, Cohen J, et al. Continuous deep sedation at the end of life of children in Flanders, Belgium. J Pain Symptom Manage 2011; 41:449- 455. The present study is one of the first in literature to investigate the practice of continuous deep sedation in minors across different patient groups and care settings. The authors estimated the incidence of continuous deep sedation in minor patients (aged 1-17 years) and described the characteristics of, and the decision-making process before, continuous deep sedation. However, only the physician's perspective was studied; the perspective of parents was not included. The present study was retrospective and descriptive; thus, less suitable for providing in-depth explanations of its findings.
6. Postovsky S, Moaed B, Krivoy E, et al. Practice of palliative sedation in children with brain tumors and sarcomas at the end of life. Pediatr Hematol Oncol 2007; 24:409-415. The authors evaluated retrospectively the indications, incidence, and characteristics of palliative sedation (PS) in 19 children with brain tumors and 18 with sarcomas (S) at the end of life. Twelve out of the 18 S patients received PS, as did 13 of the 19 BT patients. (Pubitemid 47301147)
7. Kenny NP, Frager G. Refractory symptoms and terminal sedation of children: ethical issues and practical management. J Palliat Care 1996; 12:40-45. The authors describe concerns about the decision making process and about what is understood as refractory symptoms in children PC, parenting suffering and how it may influence the staff decision for EOLS, indications for terminal sedation and dosing. They developed an ethical framework to make us think about these complex issues even though it was written as long ago as 1996. (Pubitemid 126673618)
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23. Pousset G, Bilsen J, Cohen J, et al. Medical end-of-life decisions in children in Flanders. Belgium Arch Pediatr Adolesc Med 2010; 164:547- 553. Medical EOL decisions are frequent in minors in Flanders, Belgium. Although parents were involved in most EOL decisions, the patients themselves were involved much less frequently, even when the ending of their lives was intended.
24. Kars M, Grypdonck M, Beishuizen A, et al. Factors influencing parental readiness to let their child with cancer die. Pediatr Blood Cancer 2010; 54:1000-1008. The authors mention that one in four cases of childhood cancer is incurable. In these cases, death can usually be anticipated and therefore preceded by a phase of palliative care. For parents, preparing to let their child die is an extraordinarily painful process. Most struggle to preserve their child. This study identified, from a parental perspective, the main factors that influence the transition from preserving life to letting go.
25. Rishel C. Conceptual framework for the study of parental end-of-life decision making in pediatric blood and marrow transplantation. Oncol Nurs Forum 2010; 37:184-190. The author described a conceptual framework that she believes will facilitate research and practice concerning parental EOL decision making in pediatric blood and marrow transplantation.
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