Chapitre 5. Évaluer le confort du patient en contexte de pratiques sédatives : enjeux éthiques des innovations en médecine palliative.

In the context of end of life, palliative care offers support for the patient and his family, from a global perspective. This means paying attention to pain and difficult symptoms, but also to psychological, social and spiritual issues. Some situations confront healthcare teams with the difficulty of providing support to the end of life, not only in terms of relieving pain and suffering, but also when communication is impaired or even impossible. This is particularly the case with sedative practices. These situations involve providing comprehensive support by different evaluations of the patient’s pain and discomfort. This is therefore carried out by hetero-evaluation, by following observational pain assessment scales. Monitoring devices, such as ANI, usually used in anesthesia services, are experimented, for clinical purposes but also for research. In this article, we propose to analyze a clinical situation in which the use of ANI raised a whole series of questions about the use of the technical approach in palliative medicine and its integration into a care team. We will question some issues, in context, on the use of techniques and technologies in palliative medicine.