• Harv Rev Psychiatry · Jan 2008

    Review

    The use of palliative sedation for existential distress: a psychiatric perspective.

    • Zev Schuman-Olivier, David H Brendel, Marshall Forstein, and Bruce H Price.
    • Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA 02139, USA. zschuman-olivier@cha.harvard.edu
    • Harv Rev Psychiatry. 2008 Jan 1;16(6):339-51.

    AbstractThis article introduces a structure for standardization in the ongoing debate about the application of palliative sedation for psychological and existential suffering at the end of life. We differentiate the phenomenon of existential distress from the more general one of existential suffering, defining existential distress as a special case of existential suffering that applies to persons with terminal illness. We introduce both a clinical classification system of existential distress based on proximity to expected death and a decision-making process for considering palliative sedation (represented by the mnemonic, TIRED). Neuropsychiatric clinical cases will be used to demonstrate some of the concepts and ethical arguments.

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