The Principles of Revised Clinical Guidelines about Palliative Sedation Therapy of the Japanese Society for Palliative Medicine

Abstract

<b><i>Background:</i></b> When the suffering of a terminally ill patient is intolerable and refractory, sedatives are sometimes used for symptom relief. <b><i>Objective:</i></b> To describe the main principles of revised Japanese clinical guidelines about palliative sedation therapy. <b><i>Design:</i></b> Consensus methods using the Delphi technique were used. <b><i>Results:</i></b> The main principles of the guidelines that were newly defined or developed are as follows: (1) palliative sedation was defined as "administration of sedatives for the purpose of alleviating refractory suffering" (excluding the aim of reducing patient consciousness); (2) palliative sedation was classified according to the method of administration of sedatives: respite sedation versus continuous sedation (including (continuous) proportional sedation and continuous deep sedation); (3) a description of state-of-the-art recommended treatments for difficult symptoms such as delirium, dyspnea, and pain before the symptom was determined as refractory was included; (4) the principle of proportionality was newly defined from an ethical point of view; and (5) families' consent was regarded as being desirable (mandatory in the previous version). <b><i>Conclusions:</i></b> We described the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Further consensus building is necessary.