A clinical case of “palliative sedation” in a person with intellectual developmental disorder: reflections and considerations

Introduction: Patients with intellectual developmental disorders present a high level of health vulnerability. Their main needs concern the management of physical and psychiatric symptoms, as well as issues related to communication. Treatment decisions are often hindered by a lack of accessible information, social prejudice and insufficient specialist training of healthcare professionals in the care of these patients. Objectives: To examine the critical issues emerging along the clinical pathway, with particular reference to: 1) The appropriateness of the indication for palliative sedation; 2) the approach of medical staff toward individuals with intellectual disability; 3) bioethical concerns; 4) the management of severe disability in the hospital setting. Materials and Methods: Data were collected from clinical records available at the patient’s long-term residential care facility and the Emergency Department (ED), as well as from reports based on the shared experiences of clinicians involved in the care process and discussed during clinical audit sessions. Results: This paper reviews the clinical course of a patient with severe intellectual disability and physical comorbidities who was transferred from her long-term care residence to the ED for urgent surgical evaluation. The patient was considered “inoperable” by ED physicians and was subsequently started on a palliative sedation procedure. Discussion and Conclusions: The case was reviewed during a clinical audit, providing an opportunity to reflect on hospital care pathways for individuals with severe psychophysical disabilities. Palliative sedation is a therapeutic intervention reserved for selected patients, and healthcare professionals’ approaches to patients with disabilities may be influenced by prejudicial attitudes.