Sedação paliativa: análise bioética de um caso real em final de vida

Introduction: Ethically conscious Palliative Care represents complex challenges, particularly with regard to the management of refractory symptoms such as pain. Palliative sedation has been subject of intense debate, as it involves ethically controversial issues, leading health professionals, patients, and family members to be confronted with conflicts regarding its initiation. Objectives: To promote a bioethical reflexion on the institution of palliative sedation in patients actively dying. Material and methods: Based on a clinical case, we intend to develop a bioethical analysis of the topic of palliative sedation initiation and its complexity, based on the literature and ethical principles. Results: Ethical reflections on palliative sedation have been based on the principles of double effect, proportionality, and autonomy. These highlight the intentionality of the medical act and the existence of proportional reasons in the choice of palliative sedation, considering the patient’s autonomous decision. The principles on beneficence and non-maleficence define that the initiation of palliative sedation should be a beneficial act for the patient with the least negative impact possible. The health care provided must be fair and appropriate to the person and their clinical situation. Conclusions: Given the deontological conduct, palliative sedation is an ethically permissible therapy, which has nothing to do with medically assisted suicide or euthanasia. The decision-making process of its institution must occur as a result of a multidisciplinary teamwork, based on the will and/or the consent of the person that is actively dying. A compreensive approach to the patient is necessary, and the intervention of a team specialized in Palliative Care essential.