PALLIATIVE SEDATION IN CONTROLLING THE REFRACTORY SYMPTOMS IN ONCOLOGIC PATIENTS. A BIOETHICAL APPROACH
Authors: Valentin Petre-Ciudin1, Cornel Petre-Ciudin2, Andreea A. Velnic1, Bianca Hanganu1, Irina Manoilescu1, Dragos Crauciuc1, Beatrice G. Ioan1
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Palliative care asserts the importance of life, consider- ing that the human beings have the right to be cared and respected until the last moment of their lives. In oncologic patients, physical symptoms in general, and pain, in particular, are enhanced by psychological, social, cultural and spiritual issues. Along with progression of the disease, symptoms may become overwhelmed- ing and refractory to usual therapeutic approaches, despite the efforts, sometimes even aggressive, to identify a tolerable therapy which does not compromise the consciousness and relieves pain. One of the solutions may be palliative sedation, which means the voluntary administration of the opioids and non-opioids drugs in adequate doses and concentrations in order to lower the consciousness as much as necessary to ameliorate one or more symptoms which are refractory to other therapies. Palliative sedation, since the proposition of its practice in the healthcare of the terminal patient, with unbearable pain, generated numerous dilemmas and debates which are still ongoing. In this paper, the authors approach the issue of the palliative sedation both from medical and ethical perspectives, highlighting the importance of placing the patient in the center of the decision-making process regarding the medical treatment and its guidance according to the risks and benefits for the patient.