How to implement continuous deep sedation until death ?

Continuous deep sedation until death (CDSUD) enables a suspension of consciousness which continues until death. The French Law regulates the circumstances in which it is implemented, either after a patient’s request in specific circumstances or on physician’s initiative, in hospital, at home or in residential care institution for dependent adults.

This guide is directed toward all healthcare professionals, in particular primary care professionals: it describes the circumstances in which CDSUD is implemented and what to do before in order to verify that the conditions established by law are met. It points out organisational requirements and proposes therapeutic and monitoring procedures. A best practice guideline will clarify pharmacological treatment (ongoing).

Key points

• The French Law has created the right for a patient to request to avoid any suffering and unreasonable obstinacy.

• Continuous deep sedation until death can be implemented if the patient suffers from a serious and incurable condition which is life-threatening in the short term (few hours or days) and if the pain is refractory to treatment. In the other circumstances, a sedation “proportionate” to the severity of the symptoms is discussed with the patient.

• Assessments are interdisciplinary and multiprofessional; the team in charge of the patient’s care can early rely on a skilled palliative care team, including by phone when patient is at home or in a residential care institution for dependent adults.

• A collegial procedure, i.e a collective deliberation process among the team, is required by law before making a decision for CDSUD : it involves all professionals in charge of the patient’s care and of the implementation of continuous deep sedation until death.

• The physician in charge of the patient’s care, responsible for the decision, writes the prescription and assists the nurse during initiation of the treatment; then, they must be available 24 hours a day.

• Analgesic treatments are mandatory, artificial hydration and nutrition are treatments that should be stopped.

• Support must be provided to friends and family before, during and after sedation.

• Being careful of suffering of professionals must allow reducing it by individual or team measures.