Allysa Ciancio is a third year student at the University of Toronto. She is currently pursuing a degree in health studies, bioethics and religion. After graduation, Allysa plans to attain her MSW with a specialization in gerontology and palliative or end-of-life care. Working in collaboration with the National Initiative of Care for the Elderly, Allysa plans to continue her research related to aging and end-of-life care, especially in diverse social environments.
Existential Suffering and Palliative Sedation: A Mini-Scoping Review on Practices, Ethical Considerations and Guidelines
Background: Existential suffering is one type of refractory symptom that may be experienced as a result of treatment for, or suffering from a terminal illness. It may include – but is not limited to – feelings of hopelessness, helplessness, fear of death and loss of dignity. Like refractory physical and psychological symptoms, a treatment option for existential suffering currently includes palliative or terminal sedation. Using palliative sedation to treat existential suffering in terminally ill patients poses great ethical and methodological dilemmas for health care professionals. Though this practice is legal in Canada, there are many questions about policies and guidelines as there is little-to-no recognized framework outlined at a federal level. This lack of guidance is highlighted due to the fact there is very little research pertaining to palliative sedation specifically to treat existential suffering. A scoping review was undertaken to highlight the gaps in the research, work towards creating a better understanding of the progression of the practice, and succinctly outline the ethical implications. Once these gaps were highlighted, the information found was used to suggest how it may inform future practice, policy and research in Canada.
Research Question: How does palliative sedation effect the experience of existential suffering in older adults, aged 65 years and over?
Methods: Scoping review of four electronic databases following Arksey and O’Malley’s framework (2005) using population and intervention (older adults aged 65 and over, palliative sedation) as scope. Search of recognized federal organization for guidelines (grey literature). The search returned 385 results, of which all abstracts were skimmed. After removing articles that were not written in English, the duplicates and those without abstracts on the databases, and those whose abstracts did not explicitly mention palliative sedation and existential distress, 19 remained. Those that were included were applicable to a North American context.
Results: Eight articles fit all the inclusion criteria. One grey literature piece was used to demonstrate current health system level guidelines specific to a Canadian context.