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Open Access Highly Accessed Research article

Consensus guidelines on analgesia and sedation in dying intensive care unit patients

Laura A Hawryluck12*, William RC Harvey3, Louise Lemieux-Charles4 and Peter A Singer235

Author Affiliations

1 Ian Anderson Continuing Education Program In End of Life Care, Toronto; Canada

2 University of Health Network, University of Toronto, Toronto, Canada

3 University of Toronto Joint Centre for Bioethics, Toronto

4 Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

5 Department of Medicine, University of Toronto

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BMC Medical Ethics 2002, 3:3  doi:10.1186/1472-6939-3-3

Published: 12 August 2002

Abstract

Background

Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia.

Methods

Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12).

Results

After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU.

Conclusion

Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

Keywords:
Palliation; Death; Sedation; Analgesia; Double effect; Terminal sedation; Euthanasia; Assisted suicide; Consensus guidelines; Intensive Care