Sédation en fin de vie : enjeux relationnels

Abstract : End-of-life situations may, in case of refractory symptoms, resort to pharmacological sedation. These situations are the site of important relational issues. This work aimed to question the scientific and medical literature on how sedation can be part of these relational issues of the end of life. Our narrative review of the literature focused on eight electronic databases. It was restricted to documents published in English or French before October 31, 2017. Sixty-three documents matched the search criteria. They showed that the patient, the relatives and the carers evolve in a certain temporality, and that the suffering at the end of the life is first of all a relational suffering. This should not be considered individually and statically. Otherwise, the risk is to use sedation not to relieve symptoms, but to escape the relationship. Such a risk may come from the patient, attempting to engage in a sacrificial logic, or from those around him who are tempted to anticipate the kind of separation of psychic and social euthanasia. The different practices of sedation thus testify to more general underlying care perspectives. While a terminal sedation is similar to a procedure of disconnection subject to technical criteria and self-determination of the patient - this is the case of the Leonetti-Claeys device - palliative sedation remains proportionate to the symptoms and remains inscribed in a relational dynamic.
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Jérôme Sainton. Sédation en fin de vie : enjeux relationnels. Médecine humaine et pathologie. Faculté de médecine de Reims, 2018. Français. ⟨tel-01724700⟩

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