• Kengo Imai, Tatsuya Morita, Tatsuo Akechi, Mika Baba, Takashi Yamaguchi, Hiroko Sumi, Shimon Tashiro, Kaoruko Aita, Tetsuro Shimizu, Jun Hamano, Go Sekimoto, Isseki Maeda, Takuya Shinjo, Jun Nagayama, Eriko Hayashi, Yukie Hisayama, Kazuto Inaba, Hirofumi Abo, Akihiko Suga, and Masayuki Ikenaga.
• Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
• J Palliat Med. 2020 Sep 1; 23 (9): 1184-1190.

AbstractBackground: When the suffering of a terminally ill patient is intolerable and refractory, sedatives are sometimes used for symptom relief. Objective: To describe the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Design: Consensus methods using the Delphi technique were used. Results: The main principles of the guidelines that were newly defined or developed are as follows: (1) palliative sedation was defined as "administration of sedatives for the purpose of alleviating refractory suffering" (excluding the aim of reducing patient consciousness); (2) palliative sedation was classified according to the method of administration of sedatives: respite sedation versus continuous sedation (including (continuous) proportional sedation and continuous deep sedation); (3) a description of state-of-the-art recommended treatments for difficult symptoms such as delirium, dyspnea, and pain before the symptom was determined as refractory was included; (4) the principle of proportionality was newly defined from an ethical point of view; and (5) families' consent was regarded as being desirable (mandatory in the previous version). Conclusions: We described the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Further consensus building is necessary.

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