Euthanasia vs. Palliative Sedation
Research for Evidence Based Practice & outcome management Nurs 680
April 28, 2013
Euthanasia vs. Palliative Sedation
In this paper the author will discuss the difference between euthanasia, physician assisted suicide, and palliative sedation. The author will discuss the legal and ethical side of palliative sedation. Palliative sedation is where they use education to induce or decrease awareness of one's intractable suffering at the end of life (Olsen, Swetz, & Mueller, 2010, p. 949). They use this type of sedation when other most common forms of pain control does not relieve the pain the patient is feeling. Not only is it used to treat pain but it is also used to treat delirium, pain, dyspnea, nausea or other physical symptoms (Olsen et al., 2010, p. 950). In the aftermath of Hurricane Katrina reviewers concluded that physicians choice of benzodiazepines instead of barbiturates indicated a goal of palliative rather than euthanasia, stating that barbiturates were more deadly. Some institutions used ketamine or propoful in patients condition is refractory to opioids and midazolam. Opiates should not be used for primary purpose of sedation, but rather should be continued adjunctively during palliative sedation for analgesic purpose to prevent opiate withdrawal (Olsen et al., 2010, p. 950). Usually palliative sedation is given in a form of continuous drip but there has been times when palliative sedation has been given intermittently. Palliative sedation should be given in the areas of general care or hospice settings, ICU settings can be too hectic and uncomfortable for families. Cardiac monitoring is no good in achieving the goals of palliative sedation (Olsen et al., 2010, p. 951). Before palliative care is given written consent should be obtained by the patient or the patients family. In the state f Arizona the Arizona State Board of Nursing has develop an advisory opinion of the scope of practice of what palliative sedation is. it states that it is in the scope of practice for the register nurse to administer medications that provide palliative sedation at the end of life (Brewer & Ridenour, 2010, p. 1). Arizona State board of Nursing defined palliative sedation as follows: The monitored use of medications intended to provide relief of refractory symptoms but not to intentionally hasten death (Brewer & Ridenour, 2010, p. 1). What is a refractory symptom? It is one that cannot be adequately controlled in a tolerable time frame despite aggressive use of usual therapies and seems unlikely to be adequately controlled by further invasive or noninvasive therapies without excessive or intolerable acute or chronic side effects or complications (Brewer & Ridenour, 2010, p. 1). In Arizona's advisory opinion they rote general requirements that must be followed and they are listed below: * Written Policy and Procedure is maintained by the employer. * Administration of medications must be on the order of a person licensed in this state to prescribe such medications. * The patent has to have sufficient level of nursing care to maintained sedation. * The agency has identified medications allowed for palliative sedation, preferably y an interdisciplinary committee including nurses. * Pre-sedation symptom assessment is performed by the RN
* Post-sedation symptom assessment and ongoing assessments performed by the RN (Brewer & Ridenour, 2010, p. 1) * Only an RN with all of the following criteria are permitted to administer medications for palliative sedation. * Current certification in basic Life Support ( BLS).
* The RN must possess sufficient knowledge about the issues surrounding the use of palliative sedation to inform patients, families, and other health care providers in making decisions about its use.(Brewer & Ridenour, 2010, p. 1).
Palliative sedation is also referred to as terminal...
References: Berghs, M., Dierckx, B., & Gastmans, C. (2013). The complexity of nurses’ attitudes toward euthanasia: a review of the literature. Journal of Medical Ethics, 31. Retrieved from www.jmedethics.com
Brewer, J. K., & Ridenour, J. (2010). Advisory Opinion Palliative Sedation AT END OF LIFE. Retrieved from Http://www.azbn.gov
Lawson, M. (2011). Palliative Sedation. Clinical Journal of Oncology Nursing, 15 (6)(15).
Nevidjon, B. M., & Mayer, D. K. (2012). Death is Not an Option, How You Die Is. Oncology Nursing, 30 (3), 148-152. Retrieved from http://www.medscape.com
Olsen, M., Swetz, K., & Mueller, P. (2010). Ethical Decision Making with End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments. Mayo Clinic Proceedings, 85 (10), 949-954.
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