Artificial nutrition and hydration

 Terminally ill patients will physiologically reduce their caloric intake, and families must be
adequately prepared.

 Nutritional support may be withdrawn completely at the dying phase according to patient wishes. 

 Inadequate hydration may quicken the patient’s death → should be tailored to the individual case

Palliative sedation
 Therapeutic goal: 

o Resolving/alleviating refractory or intractable symptoms such as pain, dyspnea,

or delirium in terminally ill patients (as opposed to terminating their life)

o Legal in all countries

 Indications:

o Terminal illness with a discouraging prognosis and certainty of death 

o Traditional or conventional therapies are incapable of providing relief despite maximal

doses.

o Traditional therapies cannot provide relief of symptoms in a timely manner.

o Conventional therapies at high doses or with frequent administration will produce

adverse outcomes.

 Timing: depends on a multiplicity of factors, including diagnosis, patient age, responsiveness to

treatment, and the clinician’s judgement

 Discussion with the patient and family:

o Hinges on adequate disclosure of information, aligning the patient’s/family’s desires, and

proper determination of capacity of the patient or the surrogate

o If a decision to start palliative sedation is reached, written informed consent should be

obtained and documented in the record. 

 Pharmacologic agents used may include the following:

o Benzodiazepines

o Antipsychotics

o Opioid analgesics
  Challenges:

o Poor communication between clinicians and their patients or surrogates

o Lack of end-of-life care planning

o Controversy regarding palliative sedation: mistakenly understood to be “slow euthanasia”

Artificial nutrition and hydration

 Terminally ill patients will physiologically reduce their caloric intake, and families must be
adequately prepared.

 Nutritional support may be withdrawn completely at the dying phase according to patient wishes. 

 Inadequate hydration may quicken the patient’s death → should be tailored to the individual case

Palliative sedation
 Therapeutic goal: 

o Resolving/alleviating refractory or intractable symptoms such as pain, dyspnea,

or delirium in terminally ill patients (as opposed to terminating their life)

o Legal in all countries

 Indications:

o Terminal illness with a discouraging prognosis and certainty of death 

o Traditional or conventional therapies are incapable of providing relief despite maximal

doses.

o Traditional therapies cannot provide relief of symptoms in a timely manner.

o Conventional therapies at high doses or with frequent administration will produce

adverse outcomes.

 Timing: depends on a multiplicity of factors, including diagnosis, patient age, responsiveness to

treatment, and the clinician’s judgement

 Discussion with the patient and family:

o Hinges on adequate disclosure of information, aligning the patient’s/family’s desires, and

proper determination of capacity of the patient or the surrogate

o If a decision to start palliative sedation is reached, written informed consent should be

obtained and documented in the record. 
  Pharmacologic agents used may include the following:

o Benzodiazepines

o Antipsychotics

o Opioid analgesics

 Challenges:

o Poor communication between clinicians and their patients or surrogates

o Lack of end-of-life care planning

o Controversy regarding palliative sedation: mistakenly understood to be “slow euthanasia”

nutrition and hydration

 Terminally ill patients will physiologically reduce their caloric intake, and families must be
adequately prepared.

 Nutritional support may be withdrawn completely at the dying phase according to patient wishes. 

 Inadequate hydration may quicken the patient’s death → should be tailored to the individual case

Palliative sedation
 Therapeutic goal: 

o Resolving/alleviating refractory or intractable symptoms such as pain, dyspnea,

or delirium in terminally ill patients (as opposed to terminating their life)

o Legal in all countries

 Indications:

o Terminal illness with a discouraging prognosis and certainty of death 

o Traditional or conventional therapies are incapable of providing relief despite maximal

doses.

o Traditional therapies cannot provide relief of symptoms in a timely manner.

o Conventional therapies at high doses or with frequent administration will produce

adverse outcomes.

 Timing: depends on a multiplicity of factors, including diagnosis, patient age, responsiveness to

treatment, and the clinician’s judgement

 Discussion with the patient and family:

 o Hinges on adequate disclosure of information, aligning the patient’s/family’s desires, and
proper determination of capacity of the patient or the surrogate

o If a decision to start palliative sedation is reached, written informed consent should be

obtained and documented in the record. 

 Pharmacologic agents used may include the following:

o Benzodiazepines

o Antipsychotics

o Opioid analgesics

 Challenges:

o Poor communication between clinicians and their patients or surrogates

o Lack of end-of-life care planning

o Controversy regarding palliative sedation: mistakenly understood to be “slow euthanasia”

Artificial nutrition and hydration

 Terminally ill patients will physiologically reduce their caloric intake, and families must be
adequately prepared.

 Nutritional support may be withdrawn completely at the dying phase according to patient wishes. 

 Inadequate hydration may quicken the patient’s death → should be tailored to the individual case

Palliative sedation
 Therapeutic goal: 

o Resolving/alleviating refractory or intractable symptoms such as pain, dyspnea,

or delirium in terminally ill patients (as opposed to terminating their life)

o Legal in all countries

 Indications:

o Terminal illness with a discouraging prognosis and certainty of death 

o Traditional or conventional therapies are incapable of providing relief despite maximal

doses.

o Traditional therapies cannot provide relief of symptoms in a timely manner.

 o Conventional therapies at high doses or with frequent administration will produce
adverse outcomes.

 Timing: depends on a multiplicity of factors, including diagnosis, patient age, responsiveness to

treatment, and the clinician’s judgement

 Discussion with the patient and family:

o Hinges on adequate disclosure of information, aligning the patient’s/family’s desires, and

proper determination of capacity of the patient or the surrogate

o If a decision to start palliative sedation is reached, written informed consent should be

obtained and documented in the record. 

 Pharmacologic agents used may include the following:

o Benzodiazepines

o Antipsychotics

o Opioid analgesics

 Challenges:

o Poor communication between clinicians and their patients or surrogates

o Lack of end-of-life care planning

o Controversy regarding palliative sedation: mistakenly understood to be “slow euthanasia”

VV Artificial nutrition and hydration

 Terminally ill patients will physiologically reduce their caloric intake, and families must be
adequately prepared.

 Nutritional support may be withdrawn completely at the dying phase according to patient wishes. 

 Inadequate hydration may quicken the patient’s death → should be tailored to the individual case

Palliative sedation
 Therapeutic goal: 

o Resolving/alleviating refractory or intractable symptoms such as pain, dyspnea,

or delirium in terminally ill patients (as opposed to terminating their life)

o Legal in all countries

 Indications:
 o Terminal illness with a discouraging prognosis and certainty of death 

o Traditional or conventional therapies are incapable of providing relief despite maximal

doses.

o Traditional therapies cannot provide relief of symptoms in a timely manner.

o Conventional therapies at high doses or with frequent administration will produce

adverse outcomes.

 Timing: depends on a multiplicity of factors, including diagnosis, patient age, responsiveness to

treatment, and the clinician’s judgement

 Discussion with the patient and family:

o Hinges on adequate disclosure of information, aligning the patient’s/family’s desires, and

proper determination of capacity of the patient or the surrogate

o If a decision to start palliative sedation is reached, written informed consent should be

obtained and documented in the record. 

 Pharmacologic agents used may include the following:

o Benzodiazepines

o Antipsychotics

o Opioid analgesics

 Challenges:

o Poor communication between clinicians and their patients or surrogates

o Lack of end-of-life care planning

o Controversy regarding palliative sedation: mistakenly understood to be “slow euthanasia”

g Artificial nutrition and hydration

 Terminally ill patients will physiologically reduce their caloric intake, and families must be
adequately prepared.

 Nutritional support may be withdrawn completely at the dying phase according to patient wishes. 

 Inadequate hydration may quicken the patient’s death → should be tailored to the individual case

Palliative sedation
 Therapeutic goal: 
 o Resolving/alleviating refractory or intractable symptoms such as pain, dyspnea,
or delirium in terminally ill patients (as opposed to terminating their life)

o Legal in all countries

 Indications:

o Terminal illness with a discouraging prognosis and certainty of death 

o Traditional or conventional therapies are incapable of providing relief despite maximal

doses.

o Traditional therapies cannot provide relief of symptoms in a timely manner.

o Conventional therapies at high doses or with frequent administration will produce

adverse outcomes.

 Timing: depends on a multiplicity of factors, including diagnosis, patient age, responsiveness to

treatment, and the clinician’s judgement

 Discussion with the patient and family:

o Hinges on adequate disclosure of information, aligning the patient’s/family’s desires, and

proper determination of capacity of the patient or the surrogate

o If a decision to start palliative sedation is reached, written informed consent should be

obtained and documented in the record. 

 Pharmacologic agents used may include the following:

o Benzodiazepines

o Antipsychotics

o Opioid analgesics

 Challenges:

o Poor communication between clinicians and their patients or surrogates

o Lack of end-of-life care planning

o Controversy regarding palliative sedation: mistakenly understood to be “slow euthanasia”

v Artificial nutrition and hydration

 Terminally ill patients will physiologically reduce their caloric intake, and families must be
adequately prepared.
  Nutritional support may be withdrawn completely at the dying phase according to patient wishes. 

 Inadequate hydration may quicken the patient’s death → should be tailored to the individual case

Palliative sedation
 Therapeutic goal: 

o Resolving/alleviating refractory or intractable symptoms such as pain, dyspnea,

or delirium in terminally ill patients (as opposed to terminating their life)

o Legal in all countries

 Indications:

o Terminal illness with a discouraging prognosis and certainty of death 

o Traditional or conventional therapies are incapable of providing relief despite maximal

doses.

o Traditional therapies cannot provide relief of symptoms in a timely manner.

o Conventional therapies at high doses or with frequent administration will produce

adverse outcomes.

 Timing: depends on a multiplicity of factors, including diagnosis, patient age, responsiveness to

treatment, and the clinician’s judgement

 Discussion with the patient and family:

o Hinges on adequate disclosure of information, aligning the patient’s/family’s desires, and

proper determination of capacity of the patient or the surrogate

o If a decision to start palliative sedation is reached, written informed consent should be

obtained and documented in the record. 

 Pharmacologic agents used may include the following:

o Benzodiazepines

o Antipsychotics

o Opioid analgesics

 Challenges:

o Poor communication between clinicians and their patients or surrogates

o Lack of end-of-life care planning

 o Controversy regarding palliative sedation: mistakenly understood to be “slow euthanasia”

Artificial nutrition and hydration

 Terminally ill patients will physiologically reduce their caloric intake, and families must be
adequately prepared.

 Nutritional support may be withdrawn completely at the dying phase according to patient wishes. 

 Inadequate hydration may quicken the patient’s death → should be tailored to the individual case

Palliative sedation
 Therapeutic goal: 

o Resolving/alleviating refractory or intractable symptoms such as pain, dyspnea,

or delirium in terminally ill patients (as opposed to terminating their life)

o Legal in all countries

 Indications:

o Terminal illness with a discouraging prognosis and certainty of death 

o Traditional or conventional therapies are incapable of providing relief despite maximal

doses.

o Traditional therapies cannot provide relief of symptoms in a timely manner.

o Conventional therapies at high doses or with frequent administration will produce

adverse outcomes.

 Timing: depends on a multiplicity of factors, including diagnosis, patient age, responsiveness to

treatment, and the clinician’s judgement

 Discussion with the patient and family:

o Hinges on adequate disclosure of information, aligning the patient’s/family’s desires, and

proper determination of capacity of the patient or the surrogate

o If a decision to start palliative sedation is reached, written informed consent should be

obtained and documented in the record. 

 Pharmacologic agents used may include the following:

o Benzodiazepines

o Antipsychotics
 o Opioid analgesics

 Challenges:

o Poor communication between clinicians and their patients or surrogates

o Lack of end-of-life care planning

o Controversy regarding palliative sedation: mistakenly understood to be “slow euthanasia”

Artificial nutrition and hydration

 Terminally ill patients will physiologically reduce their caloric intake, and families must be
adequately prepared.

 Nutritional support may be withdrawn completely at the dying phase according to patient wishes. 

 Inadequate hydration may quicken the patient’s death → should be tailored to the individual case

Palliative sedation
 Therapeutic goal: 

o Resolving/alleviating refractory or intractable symptoms such as pain, dyspnea,

or delirium in terminally ill patients (as opposed to terminating their life)

o Legal in all countries

 Indications:

o Terminal illness with a discouraging prognosis and certainty of death 

o Traditional or conventional therapies are incapable of providing relief despite maximal

doses.

o Traditional therapies cannot provide relief of symptoms in a timely manner.

o Conventional therapies at high doses or with frequent administration will produce

adverse outcomes.

 Timing: depends on a multiplicity of factors, including diagnosis, patient age, responsiveness to

treatment, and the clinician’s judgement

 Discussion with the patient and family:

o Hinges on adequate disclosure of information, aligning the patient’s/family’s desires, and

proper determination of capacity of the patient or the surrogate
 o If a decision to start palliative sedation is reached, written informed consent should be
obtained and documented in the record. 

 Pharmacologic agents used may include the following:

o Benzodiazepines

o Antipsychotics

o Opioid analgesics

 Challenges:

o Poor communication between clinicians and their patients or surrogates

o Lack of end-of-life care planning

o Controversy regarding palliative sedation: mistakenly understood to be “slow euthanasia”

Artificial nutrition and hydration

 Terminally ill patients will physiologically reduce their caloric intake, and families must be
adequately prepared.

 Nutritional support may be withdrawn completely at the dying phase according to patient wishes. 

 Inadequate hydration may quicken the patient’s death → should be tailored to the individual case

Palliative sedation
 Therapeutic goal: 

o Resolving/alleviating refractory or intractable symptoms such as pain, dyspnea,

or delirium in terminally ill patients (as opposed to terminating their life)

o Legal in all countries

 Indications:

o Terminal illness with a discouraging prognosis and certainty of death 

o Traditional or conventional therapies are incapable of providing relief despite maximal

doses.

o Traditional therapies cannot provide relief of symptoms in a timely manner.

o Conventional therapies at high doses or with frequent administration will produce

adverse outcomes.
 Timing: depends on a multiplicity of factors, including diagnosis, patient age, responsiveness to
treatment, and the clinician’s judgement

 Discussion with the patient and family:

o Hinges on adequate disclosure of information, aligning the patient’s/family’s desires, and

proper determination of capacity of the patient or the surrogate

o If a decision to start palliative sedation is reached, written informed consent should be

obtained and documented in the record. 

 Pharmacologic agents used may include the following:

o Benzodiazepines

o Antipsychotics

o Opioid analgesics

 Challenges:

o Poor communication between clinicians and their patients or surrogates

o Lack of end-of-life care planning

o Controversy regarding palliative sedation: mistakenly understood to be “slow euthanasia”