Sunday, December 03, 2006

Another View on Palliative Sedation

After reading the post written by aeb, I have added my own beliefs on the topic of palliative sedation. Aeb and I are currently taking a nursing course on topics that arise when end of life is near, and palliative sedation is a topic that we have discussed in great detail.

Palliative sedation is the use of sedative medications to relieve extreme suffering that cannot be diminished with any other form of medication or treatment. These symptoms are also known as refractory symptoms. Palliative sedation puts people in an unconscious state while the disease takes its course, eventually leading to death. There has been, and still continues to be excellent interventions in our health care system for palliative care; however people are still dieing with extreme suffering. Palliative sedation is a way to help these people die in a more comfortable way. If a patient is not capable of making their own decisions and has no advanced directives, a health care surrogate can make the decision to introduce palliative sedation based on what he or she thinks the patient may have wanted. There is much to consider when discussing palliative sedation, but if a patient has a terminal illness, has extreme suffering, and no other methods to relieve either physical, emotional, or spiritual pain are working, why not do something that will ultimately put an end to this suffering?

Suffering is subjective, and many people seem to forget about the emotional factors that arise when death is imminent. A dieing patient may have extreme anxiety about leaving behind loved ones, unfinished business, or many other various factors that create extreme anxiety while dieing. Why should these feelings be any less important than physical pain, difficulty breathing, or nausea? It's unfortunate that some physicians feel emotional difficulties are not an appropriate reason to use palliative sedation. Why not do the most possible to create the most comfort? If palliative sedation is the only thing left to try then what else is there left to loose?

Palliative sedation also comes down to autonomy; in that the patient has the right to make his or her own decisions regarding the care they receive. What makes this difficult is that clinicians are not obligated to provide care that violates his or her values and morals. On the other hand, clinicians need to provide care that benefits and promotes the patients well-being. If they refuse to use palliative sedation and nothing else is providing relief from suffering, are they promoting the well-being of that patient? They are obligated to do good and prevent the patient from harm, but what is causing harm is subjective and many clinicians have an issue with making decisions based on subjective information. Our health care system has always said that pain is whatever the patient says it is, so why should palliative sedation fall into different circumstances?

Palliative sedation has recently begun to be used more frequently. Patients are finally dieing comfortably either in their own homes or the hospital setting. Many people have thought of palliative sedation as being the same as physician assisted suicide; I just wanted to point out that there is a difference. Palliative sedation is not using a medication that will immediately end a life; it is putting a person in a state of mind so that they are unaware of their extreme suffering. It is not helping to "fix" the disease or illness, but promoting comfort so the patient can be free of pain and die peacefully. Isn't that all of our hopes, to die peacefully? When a terminally ill patient is at the end of life, palliative sedation is a good alternative to other medications and treatments that are not relieving pain and suffering that come with death.


Anonymous said...

Please, there is no difference between terminal sedation (please call it what it is) and physician-assisted suicide with the exception the former prolongs the death for days or weeks, while the latter usually results in death occurring within hours, if not minutes. Physicians may feel better saying "it was the disease - not me, that caused the patient to die" but in fact death usually results from dehydration or kidney failure following the cessation of fluids, or it may be the result of the heavy sedation itself (the so-called “double effect). Terminal sedation also prolongs the agony of loved ones who must watch and wait, often leaving them with a feeling of helplessness and fear of death. Physician-assisted suicide has worked well in Oregon (the only state where it is legal) without any documented cases of abuse and studies have found the survivors not only viewed the deaths as dignified, but on average had a much shorter grieving process, perhaps because the death was quick and peaceful. In Europe terminal sedation (or palliative sedation as you call it) is correctly referred to as euthanasia, albeit “passive” rather than active.

Anonymous said...

I wrote a comment but it did not go. This is a test before I write another.

Kathryn Hinsch said...

The blogger server was done for a while and we could not publish comments. it is back up now. Please resubmit your comment.