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Walking the line. Palliative sedation for existential distress: still a controversial issue?

Palliative Sedierung in der Behandlung von existenziellem Leid – noch immer eine kontroverse Angelegenheit?

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Abstract

Adequate symptom relief is a central aspect of medical care of all patients especially in those with an incurable disease. However, as an illness progresses and the end of life approaches, physical or psychoexistential symptoms may remain uncontrollable requiring palliative sedation. Although palliative sedation has become an increasingly implemented practice in the care of terminally ill patients, sedation in the management of refractory psychological symptoms and existential distress is still a controversial issue and much debated. This case report presents a patient who received palliative sedation for the treatment of existential distress and discusses considerations that may arise from such a therapeutic approach.

Zusammenfassung

Adäquate Symptomkontrolle ist ein zentraler Aspekt in der medizinischen Behandlung von Patienten, insbesondere jener mit einer unheilbaren Erkrankung. Gerade am Lebensende kann es zu therapierefraktären physischen, psychischen und psychoexistenziellen Symptomen kommen, welche in weiterer Folge einer palliativen Sedierung bedürfen. Obwohl die Palliative Sedierung in den letzten Jahren eine zunehmend eingesetzte Therapiemethode für unheilbar kranke Patienten darstellt, ist sie in der Behandlung von therapierefraktären, psychologischen Symptomen und existenziellem Leid weiterhin eine kontrovers diskutierte Angelegenheit. Der nachfolgende Fall schildert die Geschichte eines Patienten welcher eine palliative Sedierung auf Grund von ausgeprägtem existenziellen Leid erhielt und beschreibt die Gesichtspunkte welche bei diesem therapeutischen Vorgehen in Betracht gezogen werden müssen.

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Authors and Affiliations

  1. Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Sophie Schur, Eva K. Masel & Herbert H. Watzke

  2. Department of Palliative Medicine, University Hospital Bonn, 53127, Bonn, Austria

    Lukas Radbruch

  3. Palliative Care Consult Team, Hospital Horn-Allentsteig, Spitalgasse 10, 3580, Horn, Austria

    Dietmar Weixler

Authors
  1. Sophie Schur
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  2. Lukas Radbruch
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  3. Eva K. Masel
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  4. Dietmar Weixler
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  5. Herbert H. Watzke
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Corresponding author

Correspondence to Sophie Schur.

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Schur, S., Radbruch, L., Masel, E. et al. Walking the line. Palliative sedation for existential distress: still a controversial issue?. Wien Med Wochenschr 165, 487–490 (2015). https://doi.org/10.1007/s10354-015-0402-5

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  • DOI: https://doi.org/10.1007/s10354-015-0402-5

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