• Ethical Considerations for Sedation of Terminal Wean Patients

      Livingston, Laura
      The purpose of this paper is to examine the ethical concerns involved with the sedation of a terminal wean patient. Terminal weaning is the process of removing a patient from a ventilator (a form of life support) by removing the endotracheal tube. Prior to this procedure, the determination has been made that the patient has either a terminal illness and will not recover or will have to remain on life support to sustain life (Keene, Samples, Masini, & Byington, 2006). The determination to remove a patient from the ventilator is usually one made between the health care team, family member or surrogate, and ideally the patient themselves. Treatment focus switches from the cure of disease to comfort care at the end of life. Death can cause unbearable distress and suffering for a patient. Dyspnea, feelings of suffocation, severe fatigue, nausea, vomiting, anxiety, delirium, intractable pain, and incontinence are several of the issues a dying patient may experience (Tomko & Maxwell, 1999). Despite all efforts to comfort the patient with analgesics, anxiolytics, family support or spiritual services, the patient may continue to suffer. Palliative sedation is used to decrease the level of consciousness in these patients and to help relieve their distress and suffering (Van Wijlick, 2011). Prior to the removal of the endotracheal tube for a terminal weaning process, a patient who has been living on ventilator support may already be receiving sedatives to keep him or her comfortable. A major ethical consideration in using palliative sedation is the determination that it is different from physician-assisted suicide or euthanasia (Belgrave & Requena, 2012).