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Existential suffering is among the main symptoms refractory to treatment in people at the end of life. There is evidence in the literature on the use of palliative sedation, the controlled administration of sedative medication with the purpose of inducing a state of reduced consciousness or unconsciousness to relieve unbearable suffering experienced by people with terminal illnesses, to control existential suffering. This article presents the protocol for an integrative review which aims to analyze the evidence available in the literature on the use of palliative sedation to manage existential suffering in people with serious end-of-life illnesses. This is an integrative review protocol based on the steps described by Whittemore and Knalf, and reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). A comprehensive search strategy including carefully selected terms corresponding to the domains of interest (palliative sedation and existential suffering) will be used to search for the relevant literature in the PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, and EMBASE databases. The Endnote and Rayyan softwares will be used for data management. This integrative review aims to identify existing gaps and contribute to the presentation of information that may contribute to settling the controversy regarding the use of palliative sedation to manage refractory existential suffering at the end of life. Open Science Framework (). [ABSTRACT FROM AUTHOR]

Palliative sedation (PS) is used increasingly commonly for symptom management in terminally ill patients in the Western world. The main controversies involving PS are whether it is the same as euthanasia, whether the practice supports patient autonomy, whether sufficient safeguards are or could be in place to prevent its abuse and what its spread may mean for the future of palliative care. While other reviews consider them separately, here the legal, scientific, ethical, and pragmatic challenges to the practice are examined together to provide a broad context in which to assess the current state of the practice. [ABSTRACT FROM AUTHOR]

Intractable pain and other intolerable symptoms or the patients' wish to exercise self-determination can mandate palliative sedation. Yet, three bioethical principles must be balanced in comparable situations: one and two being beneficence (to do the best for our patient) and non-maleficence (do no harm) versus patient autonomy (the right for self-determination). Theoretically, palliative sedation incurs the potential risk of accelerating death, particularly in cases in which the disease is not advanced, because the consequences of sedation (perhaps no calorie or fluid uptake) would be likely to cause death (refusal to eat or drink sufficiently). If, however, the disease is far advanced (and the prognosticated life-span short) and the patient unwilling to eat and drink anyway, then initiated sedation might not be associated with accelerated death (and thus do harm to the patient, from an external viewpoint). Therefore, palliative sedation continues to be an area of discussion and a challenge as to when and how to implement it. Here, we introduce the case of a patient with advanced gastric cancer who asked for palliative sedation. We briefly describe his and the family's thoughts and follow the course of the disease until his death. With this report, we re-emphasize that, with precise sedation by continuous infusion of midazolam, it is possible to let the patient wake up for voiding and defecation and communicate with family members. By such individual approaches, it is possible to let the natural course of disease continue. Our patient had at no point in time asked for physician-assisted suicide. [ABSTRACT FROM AUTHOR]

At the end of life, all patients have the right to the adequate relief of physical symptoms. Consequently, there is need to ensure that appropriate infrastructural measures are addressed to enhance the likelihood that this right will be fulfilled. In order to achieve this, it is critical that symptoms at the end of life be assessed and, when relief is needed, that the adequacy of symptom relief be determined by the patient. Inadequately received symptoms in dying patients must be relieved to the patient's satisfaction and symptoms that are difficult to control must be evaluated by clinicians expert in symptom control at the end of life. When a symptom is refractory to normal palliative approaches, and only sedation can provide the needed relief, this should be available to patients with appropriate infrastructural guidelines to prevent the inappropriate application of this approach. [ABSTRACT FROM AUTHOR]