RT Journal
A1 Chambaere K, Bilsen J, Cohen J, et al
T1 Continuous deep sedation until death in belgium: A nationwide survey
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2010
FD March 8
VO 170
IS 5
SP 490
OP 493
DO 10.1001/archinternmed.2009.542
UL http://dx.doi.org/10.1001/archinternmed.2009.542
AB 
In recent years much debate has focused on the practice of continuous deep sedation until death and its acceptability on an ethical level. While many view its performance as part of normal medical practice, provided that particular safeguards are met, it is also believed to be a covert form of euthanasia in some cases and thus morally equivalent to euthanasia.1 As a result, several guidelines have been issued worldwide relating to the conditions and modalities of its use.1- 3 First, sedation should not be aimed at hastening death. The patient should be expected to die “imminently” (ie, within no more than 2 weeks) and have refractory symptoms. The continued administration of artificial nutrition or hydration is not encouraged unless the benefits outweigh the harm. Also, the use of benzodiazepines rather than opioids is recommended because the latter are known to have uncertain sedative effects and considerable adverse effects. This decision should be made with the patient or, in case of incompetence, with the family. With the exception of the Dutch national guideline issued by the Royal Dutch Medical Association in 2005 and revised in 2009,2 all guidelines are unofficial expert recommendations.