{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:51:38Z","timestamp":1777384298939,"version":"3.51.4"},"reference-count":16,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2014,12,7]],"date-time":"2014-12-07T00:00:00Z","timestamp":1417910400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:p>We present the case of a 34-year-old woman with Klippel-Feil syndrome who developed progressive generalized dystonia of unclear etiology, resulting in intractable pain despite aggressive medical and surgical interventions. Ultimately, palliative sedation was required to relieve suffering. Herein, we describe ethical considerations including defining sedation, determining prognosis in the setting of an undefined neurodegenerative condition, and use of treatments that concurrently might prolong or alter end-of-life trajectory. We highlight pertinent literature and how it may be applied in challenging and unique clinical situations. Finally, we discuss the need for expert multidisciplinary involvement when implementing palliative sedation and illustrate that procedures and rules need to be interpreted to deliver optimal patient-centered plan of care.<\/jats:p>","DOI":"10.1177\/1049909114561997","type":"journal-article","created":{"date-parts":[[2014,12,8]],"date-time":"2014-12-08T20:42:31Z","timestamp":1418071351000},"page":"363-368","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Palliative Sedation and What Constitutes Active Dying"],"prefix":"10.1177","volume":"33","author":[{"given":"Jacob J.","family":"Strand","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Section of Palliative Medicine, Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Molly A.","family":"Feely","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Section of Palliative Medicine, Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neha M.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Section of Palliative Medicine, Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan M.","family":"Moeschler","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine Mayo Clinic, Department of Anesthesiology, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith M.","family":"Swetz","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Section of Palliative Medicine, Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2014,12,7]]},"reference":[{"key":"bibr1-1049909114561997","unstructured":"AAHPM Board of Directors. Statement on Palliative Sedation; 2006. Web site. http:\/\/www.aahpm.org\/positions\/default\/sedation.html. 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