Subscribe to RSS
DOI: 10.1055/s-2004-821374
© Georg Thieme Verlag Stuttgart · New York
Sterbende sedieren?
Sedation in end-of-life care - ethical aspectsPublication History
eingereicht: 5.11.2003
akzeptiert: 12.2.2004
Publication Date:
16 March 2004 (online)

Zusammenfassung
Sedierung bei Schwerstkranken und Sterbenden spielt eine zunehmende Rolle zur Behandlung therapierefraktärer Symptome aber auch zur Minderung von Anspannung und Angst in der Sterbebegleitung. Im Zusammenhang mit der auch in Deutschland zunehmenden Selbstbestimmungs- und Euthanasiedebatte wird auch das Thema einer „terminalen Sedierung” kontrovers diskutiert. Die Berücksichtigung individueller Bedürfnisse, aber auch die Möglichkeit des Missbrauchs einer „terminalen Sedierung” zur vorzeitigen Lebensbeendigung machen es notwendig, Indikationen, Ziele, Absichten und ethische Implikationen einer medikamentösen Sedierung am Lebensende kritisch zu reflektieren und ihren Stellenwert anhand von Richtlinien zu verdeutlichen.
Summary
Sedation in the final stages of life plays an increasing role to control refractory physical and psychological symptoms and to diminish distress and anxiety in palliative care. In the debate on euthanasia and self determination also in Germany the issue of „terminal sedation” has evoked ethical concerns and is discussed controversially. With respect for personal needs the intentions, aims and indications for medical sedation should be carefully reflected under ethical aspects to clarify its position in end-of-life care
Literatur
- 1
Billings J A, Block S D.
Slow Euthanasia.
J Palliative Care.
1996;
12
21-30
MissingFormLabel
- 2
Blocher M B.
The Ethics of Terminal Sedation as a Treatment of End-of-Life Pain and Suffering.
Biblical Bioethics.
2003;
7
1-4
MissingFormLabel
- 3 Broeckaert B, NunezOlarte J M. Sedation in palliative care: facts and concepts. Buckingham: Open University Press In: ten Have H, Clark D, eds. The ethics of palliative care: European perspectives.
Facing Death series 2002: 166-180
MissingFormLabel
- 4
Byock I R.
When suffering persists.
J Palliat Care.
1994;
10
8-13
MissingFormLabel
- 5 Caraceni A. et al .Terminal Sedation: A retrospective survey of a three-year experience. www.eapcnet.org/download/forLyon2002/ selectedab-stracts/242_Caraceni.pdf
MissingFormLabel
- 6
Chater S, Viola R, Paterson J.
Jarvis: Sedation for intractable distress in the dying - a survey of experts.
Pall Med.
1998;
12
255-269
MissingFormLabel
- 7
Cherny N I, Portenoy R K.
Sedation in the management of refractory symptoms: Guidelines for evaluation
and treatment.
J Palliat Care.
1994;
10
31-38
MissingFormLabel
- 8
Chiu T Y, Hu W Y, Lue B H, Cheng S Y, Chen C Y.
Sedation for refractory symptoms of terminal cancer patients in Taiwan.
J Pain Symp Manage.
2001;
21
467-472
MissingFormLabel
- 9
Cowan J D, Palmer T W.
Practical guide to palliative sedation.
Curr Oncol Rep.
2002;
4
242-249
MissingFormLabel
- 10
Cowan J D, Walsh D.
Terminal sedation in palliative medicine - definition and review of the literature.
Support Care Cancer.
2001;
9
403-407
MissingFormLabel
- 11 Craig G. Terminal sedation. CMQ www.catholicdoctors.org.uk/CMQ/ Feb_2002/termi-nal_sedation.htm 2002
MissingFormLabel
- 12
Dahlkamp J. et al .
Tiefschlaf bis zum Tod.
Der Spiegel.
2003;
41
206-208
MissingFormLabel
- 13
Enck R E.
Drug induced terminal sedation for symptom control.
Am J Hospice Palliat Care.
1991;
8
3-5
MissingFormLabel
- 14
Fainsinger R L, Waller A. et al .
A multicentre inter-national study of sedation for uncontrolled symptoms in
terminally ill patients.
Pall Med.
2000;
14
257-265
MissingFormLabel
- 15
Førde R, Olaf G, Aasland O G, Falkum E, Breivik H, Kaasa S.
Palliative sedation to the dying patient.
Tidsskr Nor Lægeforen.
2001;
121
1085-1088
MissingFormLabel
- 16
Furst C J, Hagenfeldt K.
End-of-life sedation - definition and clinical guidelines needed.
Lakartidningen.
2002;
99
3830-3835
MissingFormLabel
- 17 Goldstein-Shirley J, Fine P G. „Ethics of Total Sedation” Total Sedation Educational Resources Draft, prepared
by a Task Force of the NHPCO. Ethics Committee (Session 8A, March 25, 2001) 1-10
MissingFormLabel
- 18
Hallenbeck J L.
Terminal Sedation: Ethical Implications in Different Situations.
J of Pall Med.
2000;
3
313-320
MissingFormLabel
- 19
Hawryluck L A, Harvey W RC. et al .
Consensus guidelines on analgesia and sedation in dying intensive care unit
patients.
BMC Medical Ethics.
2002;
3
3
MissingFormLabel
- 20
Hinkka H, Kosunen E. et al .
Decision making in terminal care: a survey of Finnish doctor’s treatment decisions
in end-of-life scenarios involving a terminal cancer and a terminal dementia
patient.
Pall Med.
2002;
16
195-204
MissingFormLabel
- 21 Irwin M. Terminal Sedation. Voluntary Euthanasia News 2001: 8-9
MissingFormLabel
- 22
Jansen L A, Sulmasy D P.
Sedation, alimentation, hydration, and equivocation: careful conversation about
care at the end of life.
Ann Intern Med.
2002;
136
845-849
MissingFormLabel
- 23 Jonas H. Philosophical Essays: From Ancient Creed to Technological Man. Englewood Cliffs, NJ: Prentice-Hall 1974: 130
MissingFormLabel
- 24
v. Kolfschooten F .
Dutch television report stirs up euthanasia controversy.
Lancet.
2003;
361
1352-1353
MissingFormLabel
- 25
Krakauer E L, Penson R T. et al .
Sedation for intractable distress of a dying patient.
The Oncologist.
2000;
5
53 62
MissingFormLabel
- 26 Materstvedt L J, Kaasa S. The ethics of terminal sedation. http://www.medisin.ntnu.no/ims/kreft/slb/Dokument/Abstract/materstvedt_og_kaasa_Palermo_29_mars.pdf Poster 7th Congress of EAPC, Palermo 2001
MissingFormLabel
- 27
Materstvedt L J, Clark D. et al .
Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force.
Pall Medicine.
2003;
17
97-101
MissingFormLabel
- 28
Morita T, Inoue S, Chihara S.
Sedation for symptom control in Japan.
J Pain Symp Manag.
1996;
12
32-38
MissingFormLabel
- 29
Morita T, Tsuneto S, Shima Y.
Definition of sedation for symptom relief: .
J Pain Symptom Manage.
2002;
24
447-453
MissingFormLabel
- 30
Morita T, Tsunoda J, Inoue S, Chihara S.
Do hospice clinicians sedate patients intending to hasten death?.
J Palliat Care.
1999;
15
20-23
MissingFormLabel
- 31
Morita T, Tsunoda J, Inoue S, Chihara S.
Terminal sedation for existential distress.
Amer J Hosp Pall Care.
2000;
3
189-195
MissingFormLabel
- 32
Müller-Busch H C.
Zur Behandlung ethischer Probleme und Konflikte bei sterbenskranken und sterbenden
Menschen.
Z Palliativmed.
2002;
3
70-77
MissingFormLabel
- 33
Muller-Busch H C, Jehser T, Andres I.
Sedation in palliative care - a critical analysis of 7 years experience.
BMC Palliat Care.
2003;
2
2
MissingFormLabel
- 34
Müller-Busch H C, Klaschik E, Oduncu F S, SchindlerT, Woskanjan S.
Euthanasie bei unerträglichem Leid: Eine Studie der Deutschen Gesellschaft für
Palliativmedizin zum Thema Sterbehilfe im Jahre 2002.
Z Palliativmed.
2003;
4
75-84
MissingFormLabel
- 35
Nunez-Olarte J M, Guillen D G.
Cultural issues and ethical dilemmas in palliative and end-of- life care in
Spain.
Cancer Control.
2001;
8
46-54
MissingFormLabel
- 36
Ojeda-Martin M, Navarro-Marrero A, Gomez-Sancho M.
Sedacion y enfermoa oncologico terminal.
Med Pal.
1997;
4
101-108
MissingFormLabel
- 37
Orentlicher D.
The Supreme Court and physician-assisted suicide - rejecting assisted suicide
but embracing euthanasia. Sounding board.
N Engl J Med.
1997;
337
1236-1239
MissingFormLabel
- 38
Porta-Sales J, Ylla-Català-Boré E, Estíbalez-Gil A. et al .
Estudio multicéntrico catalano-balear sobre la sedación terminal en Cuidados
Paliativos.
Med Pal.
1999;
6
153-158
MissingFormLabel
- 39
Porta-Sales J.
Sedation and terminal care.
EJPC.
2001;
8
97-100
MissingFormLabel
- 40
Quill T E, Lo B, Brock D W.
Palliative options of last resort. A comparison of voluntarily stopping eating
and drinking, terminal sedation, physician-assisted suicide, and voluntary active
euthanasia.
JAMA.
1997;
23
2099-104
MissingFormLabel
- 41
Radbruch L.
Reflections on the use of sedation in terminal care.
EJPC.
2002;
9
237-239
MissingFormLabel
- 42
Ramsay M AE, Savege T M, Simpson B RJ, Goodwin R.
Controlled sedation with alpaxalone-alphadolone.
Brit Med J.
1974;
2
656-659
MissingFormLabel
- 43
Rousseau P.
Existential suffering and palliative sedation: A brief commentary with a proposal
for clinical guidelines.
Am J Hosp Pall Care.
2001;
18
151-153
MissingFormLabel
- 44
Roy D.
Need they sleep before they die?.
J Pall Care.
1990;
63
3-4
MissingFormLabel
- 45
Steinhauser K E. et al .
Factors considered important at the end of life by patients, family, physicians,
and other care providers.
JAMA.
2000;
284
2476-2482
MissingFormLabel
- 46
Stone P, Phillips C, Spruyt O, Waight C.
A comparison of the use of sedatives in a hospital support team and in a hospice.
Palliat Med.
1997;
11
140-14
MissingFormLabel
- 47
Ventafridda V, Ripamonti C. et al .
Symptom prevalence and control durino cancer patients last days of life.
J Pall Care.
1990;
6
7-11
MissingFormLabel
Prof. Dr. H. Christof Müller-Busch
Abt. f. Anästhesiologie, Palliativmedizin und Schmerztherapie, am Gemeinschaftskrankenhaus
Havelhöhe
Kladower Damm 221
14089 Berlin
Phone: 030/36501160
Fax: 030/36501161
Email: muebu@havelhoehe.de