Now we lay them down to sleep: ethical issues with the use of pharmacologic coma for adult status epilepticus

The use of pharmacologic coma (PC) to treat status epilepticus (SE) is not always successful, and there are no guidelines for the duration of PC in an attempt to achieve seizure control. Using clinical cases, we explore three concepts: (1) SE as a terminal condition; (2) PC resulting in permanent unconsciousness; and (3) use of PC for extended periods. Regarding a patient's Advance Directive/Living Will, these three concepts can pose ethical complexities for the medical team due to the notions of unconsciousness, cognitive appreciation, and life support being relevant to both PC therapy as well as these documents. We argue that when PC therapy is not reversing the patient's clinical course and only offering to sustain organic life, it is ethically appropriate to discontinue such therapy and provide the patient comfort care. If PC therapy is only expected to sustain organic life, it is ethically appropriate not to offer it. (C) 2004 Elsevier Inc. All rights reserved.