Sterbende sedieren?

Zusammenfassung

Sedierung bei Schwerstkranken und Sterbenden spielt eine zunehmende Rolle zur Behandlung therapierefraktärer Symptome, aber auch zur Minderung von Anspannung und Angst in der Sterbebegleitung. Im Zusammenhang mit der auch in Deutschland zunehmenden Selbstbestimmungs- und Euthanasiedebatte wird auch das Thema einer „terminalen Sedierung” kontrovers diskutiert. Die Berücksichtigung individueller Bedürfnisse, aber auch die Möglichkeit des Missbrauchs einer „terminalen Sedierung” zur vorzeitigen Lebensbeendigung machen es notwendig, Indikationen, Ziele, Absichten und ethische Implikationen einer medikamentösen Sedierung am Lebensende kritisch zu reflektieren und ihren Stellenwert anhand von Richtlinien zu verdeutlichen.

Abstract

Sedation in the end of life plays an increasing role in controlling refractory physical and psychological symptoms and in diminishing distress and anxiety in palliative care. The issue of „terminal sedation” has evoked ethical concerns and is also discussed controversially in the debate on euthanasia and self determination in Germany. The intentions, aims and indications for medical sedation should be reflected carefully with respect to personal needs and to ethical aspects to clarify its position in end-of-life care.

Terminale Sedierung - Palliativmedizin - Symptomkontrolle - Ethik - Übersicht

Terminal sedation - palliative care - ethics - symptom control - attitudes - review

Literatur

• 1 Billings J A, Block S D. Slow Euthanasia.  J Palliative Care. 1996;  12 21-30
• 2 Blocher M B. The Ethics of Terminal Sedation as a Treatment of End-of-Life Pain and Suffering.  Biblical Bioethics. 2003;  7 1-4
• 3 Broeckaert B, Nunez Olarte J M. Sedation in palliative care: facts and concepts. In: ten Have H, Clark D (eds) The ethics of palliative care: European perspectives. Facing Death series. Buckingham; Open University Press 2002: 166-180
• 4 Byock I R. When suffering persists.  J Palliat Care. 1994;  10 8-13
• 5 Caraceni A, Zecca E, Martini C, Gorni G, Galbiatti A, Conno F De. Terminal Sedation: A retrospective survey of a three-year experience. http://www.eapcnet.org/download/forLyon2002/selectedabstracts/242_Caraceni.pdf
• 6 Chater S, Viola R, Paterson J, Jarvis V. Sedation for intractable distress in the dying - a survey of experts.  Pall Med. 1998;  12 255-269
• 7 Cherny N I, Portenoy R K. Sedation in the management of refractory symptoms: Guidelines for evaluation and treatment.  J Palliat Care. 1994;  10 31-38
• 8 Chiu T Y, Hu W Y, Lue B H, Cheng S Y, Chen C Y. Sedation for refractory symptoms of terminal cancer patients in Taiwan.  J Pain Symp Manage. 2001;  21 467-472
• 9 Cowan J D, Palmer T W. Practical guide to palliative sedation.  Curr Oncol Rep. 2002;  4 (3) 242-249
• 10 Cowan J D, Walsh D. Terminal sedation in palliative medicine - definition and review of the literature.  Support Care Cancer. 2001;  9 403-407
• 11 Craig G. Terminal sedation CMQ 2002. http://www.catholicdoctors.org.uk/CMQ/Feb_2002/terminal_sedation.htm
• 12 Dahlkamp J, Fröhlingsdorf M, Ludwig U. Tiefschlaf bis zum Tod.  Der Spiegel. 2003;  (41) 206-208
• 13 Enck R E. Drug induced terminal sedation for symptom control.  Am J Hospice Palliat Care. 1991;  8 3-5
• 14 Fainsinger R L, Waller A, Bercovici M, Bengtson K, Landman W, Hosking M. et al . A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients.  Pall Med. 2000;  14 (4) 257-265
• 15 Førde R, Olaf G, Aasland O G, Falkum E, Breivik H, Kaasa S. Palliative sedation to the dying patient.  Tidsskr Nor Lægeforen. 2001;  121 1085-1088
• 16 Furst C J, Hagenfeldt K. End-of-life sedation - definition and clinical guidelines needed.  Lakartidningen. 2002;  99 (39) 3830-3835
• 17 Goldstein-Shirley J, Fine P G. „Ethics of Total Sedation”, Total Sedation Educational Resources Draft, prepared by a Task Force of the NHPCO Ethics Committee (Session 8A, March 25, 2001). 1-10
• 18 Hallenbeck J L. Terminal Sedation: Ethical Implications in Different Situations.  J of Pall Med. 2000;  3 313-320
• 19 Hawryluck L A, Harvey W RC, Lemieux-Charles L, Singer P A. Consensus guidelines on analgesia and sedation in dying intensive care unit patients.  BMC Medical Ethics. 2002;  3 3
• 20 Hinkka H, Kosunen E, Lammi E K, Metsanoja R, Puustelli A, Kellokumpu-Lehtinen P. Decision making in terminal care: a survey of Finnish doctor's treatment decisions in end-of-life scenarios involving a terminal cancer and a terminal dementia patient.  Pall Med. 2002;  16 195-204
• 21 Irwin M. Terminal Sedation. Voluntary Euthanasia News May 2001: 8-9
• 22 Jansen L A, Sulmasy D P. Sedation, alimentation, hydration, and equivocation: careful conversation about care at the end of life.  Ann Intern Med. 2002;  136 845-849
• 23 Jonas H. Philosophical Essays: From Ancient Creed to Technological Man. Englewood Cliffs, NJ; Prentice-Hall 1974: 130
• 24 Kolfschooten F v. Dutch television report stirs up euthanasia controversy.  Lancet. 2003;  361 1352-1353
• 25 Krakauer E L, Penson R T, Truog R D, King L A, Chabner B A, Lynch T J. Sedation for intractable distress of a dying patient.  The Oncologist. 2000;  5 53-62
• 26 Materstvedt L J, Kaasa S. The ethics of terminal sedation. Poster 7^th Congress of EAPC, Palermo 2001. http://www.medisin.ntnu.no/ims/kreft/slb/Dokument/Abstract/materstvedt_og_kaasa_Palermo_29_mars.pdf
• 27 Materstvedt L J, Clark D, Ellershaw J, Førde R, Boeck Gravgaard A M, Müller-Busch H C, Porta I, Sales J, Rapin C H. Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force.  Pall Medicine. 2003;  17 97-101
• 28 Morita T, Inoue S, Chihara S. Sedation for symptom control in Japan: the importance of intermittent use and communication with family members.  J Pain Symp Manag. 1996;  12 32-38
• 29 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 (4) 447-453
• 30 Morita T, Tsunoda J, Inoue S, Chihara S. Do hospice clinicians sedate patients intending to hasten death?.  J Palliat Care. 1999;  15 (3) 20-23
• 31 Morita T, Hirai K, Okazaki Y. Preferences for Palliative Sedation Therapy in the Japanese General Population.  J Pall Med. 2002;  5 (3) 375-386
• 32 Müller-Busch H C. Zur Behandlung ethischer Probleme und Konflikte bei sterbenskranken und sterbenden Menschen.  Z Palliativmed. 2002;  3 70-77
• 33 Müller-Busch H C, Jehser T, Andres I. Sedation in palliative care - a critical analysis of 7 years experience.  BMC Palliat Care. 2003;  2 2
• 34 Müller-Busch H C, Klaschik E, Oduncu F S, Schindler T, Woskanjan S. Euthanasie bei unerträglichem Leid? Eine Studie der Deutschen Gesellschaft für Palliativmedizin zum Thema Sterbehilfe im Jahre 2002.  Z Palliativmed. 2003;  4 75-84
• 35 Nunez Olarte J M, Guillen D G. Cultural issues and ethical dilemmas in palliative and end-of-life care in Spain.  Cancer Control. 2001;  8 46-54
• 36 Ojeda Martin M, Navarro Marrero A, Gomez Sancho M. Sedacion y enfermoa oncologico terminal.  Med Pal. 1997;  4 101-108
• 37 Orentlicher D. The Supreme Court and physician-assisted suicide - rejecting assisted suicide but embracing euthanasia. Sounding board.  N Engl J Med. 1997;  337 1236-1239
• 38 Porta Sales J, Ylla-Català Boré E, Estíbalez Gil A. et al . Estudio multicéntrico catalano-balear sobre la sedación terminal en Cuidados Paliativos.  Med Pal. 1999;  6 153-158
• 39 Porta Sales J. Sedation and terminal care.  EJPC. 2001;  8 97-100
• 40 Quill T E, Lo B, Brock D W. Palliative options of last resort. A comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia.  JAMA. 1997;  23 2099-2104
• 41 Radbruch L. Reflections on the use of sedation in terminal care.  EJPC. 2002;  9 (6) 237-239
• 42 Ramsay M AE, Savege T M, Simpson B RJ, Goodwin R. Controlled sedation with alpaxalone-alphadolone.  British Medical Journal. 1974;  2 656-659
• 43 Rietjens J AC, Heide A van der, Vrakking A M, Onwuteaka-Philipsen B D, Maas P J van der, Wal G van der. Physician Reports of Terminal Sedation without Hydration or Nutrition for Patients Nearing Death in the Netherlands.  Ann of Int Med. 2004;  141 178-185
• 44 Rousseau P. Existential suffering and palliative sedation: A brief commentary with a proposal for clinical guidelines.  Am J of Hosp and Pall Care. 2001;  18 151-153
• 45 Roy D. Need they sleep before they die?.  J Pall Care. 1990;  6 (3) 3-4
• 46 Steinhauser K E, Christakis N A, Clipp E C, McNeilly M, McIntyre L, Tulsky J A. Factors considered important at the end of life by patients, family, physicians, and other care providers.  JAMA. 2000;  15, 284 2476-2482
• 47 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
• 48 Ventafridda V, Ripamonti C, Conno F De, Tamburini M, Cassileth B R. Symptom prevalence and control during cancer patients last days of life.  J Pall Care. 1990;  6 7-11