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Refractory psycho-existential distress and continuous deep sedation until death in palliative care: The French perspective

Published online by Cambridge University Press:  25 September 2019

Michel Reich Open the ORCID record for Michel Reich [Opens in a new window] ,
Xavier Bondenet ,
Laurence Rambaud ,
Fazya Ait-Kaci ,
Anne-Laure Sedda ,
Arlette Da Silva ,
Stéphanie Villet  and
Vincent Gamblin
Michel Reich*
Affiliation:
Centre Oscar Lambret, Psycho-Oncology Unit, 59020Lille, France
Xavier Bondenet
Affiliation:
Centre Oscar Lambret, Psycho-Oncology Unit, 59020Lille, France
Laurence Rambaud
Affiliation:
Centre Oscar Lambret, Psycho-Oncology Unit, 59020Lille, France
Fazya Ait-Kaci
Affiliation:
Centre Oscar Lambret, Psycho-Oncology Unit, 59020Lille, France
Anne-Laure Sedda
Affiliation:
Centre Oscar Lambret, Psycho-Oncology Unit, 59020Lille, France
Arlette Da Silva
Affiliation:
Centre Oscar Lambret, Palliative Care Unit, 59020Lille, France
Stéphanie Villet
Affiliation:
Centre Oscar Lambret, Palliative Care Unit, 59020Lille, France
Vincent Gamblin
Affiliation:
Centre Oscar Lambret, Palliative Care Unit, 59020Lille, France
*
Author for correspondence: Michel Reich, Centre Oscar Lambret, Psycho-Oncology Unit, 3 rue Frédéric Combemale, 59020Lille, France. Email: m-reich@o-lambret.fr
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Abstract

Objective

Since February 2016, French Claeys-Leonetti law has recognized patients' right to confront incurable diseases with short-term prognosis and refractory physical or psychological or existential symptoms by requesting continuous deep sedation until death (CDSUD). Determining when psychological or existential distress is refractory and unbearable remains complex and controversial.

This review provides a comprehensive thought on CDSUD for advanced incurable patients with refractory psychological and/or existential distress in palliative care settings. It offers guidance on psychiatric or psychological diagnosis for explaining patients' requests for CDSUD.

Method

A narrative literature review (2000–2019) was conducted on the MedLine search about the use of palliative sedation in cases of refractory psychological and/or existential distress.

Results

(1) Definitions of “refractory symptom,” “refractory psychological distress,” and “refractory existential distress” are inconsistent; (2) alternative diagnoses might obscure or be obscured by psycho-existential distress; and (3) criteria on meanings, reasons for requests, decision-making processes, and functions are evolving in practice.

Significance of results

Before implementing CDSUD, palliative healthcare professionals should seek input from psycho-oncologists in palliative care. Mental health professionals should analyze and assess the reasons for psychological and/or existential distress, consider the intentionality processes of requests, and explore alternative diagnoses, such as depressive or adjustment disorders, demoralization syndrome, desire to hasten death, and desire for euthanasia. Therapeutic responses (e.g., pharmacological and psychotherapeutic) should be implemented before deciding that psycho-existential distress is refractory.

Keywords

Continuous deep sedation until deathPsychological distressExistential distressEnd-of-life carePalliative careClaeys-Leonetti law
Type
Review Article
Information
Palliative & Supportive Care , Volume 18 , Special Issue 4: Palliative and Supportive Care During The COVID-19 Pandemic , August 2020 , pp. 486 - 494
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Copyright
Copyright © Cambridge University Press 2019

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