Friday, December 01, 2006

Palliative Sedation

Before taking one of my most recent nursing classes, I had not been exposed to the concept of palliative sedation. Throughout this class I have been exposed to articles which helped me to understand what palliative sedation really is. I have found many people also do not know what it is or why it would be used. I think it is important for people with friends or family members who are suffering to have an understanding of what palliative sedation is, so they are more capable of making decisions surrounding end of life care.
Palliative sedation is used done with the intent to relieve subjective and objective symptoms. Objective symptoms are those which we can see, such as crying or a pain rating of 10/10. Subjective symptoms we can not see, we can only believe what the patient is telling us. Emotional suffering is often missed because physicians have a hard time sedating a patient based merely on what they are telling you. People remain in anguish due to physicians personal struggle of knowing who is really suffering from those who just want to be sedated as an escape or to hasten their death. As a nurse and as a family member it is really important to advocate for the person who is suffering. We are the ones who know the people best and are able to validate the patients emotional suffering.
Nurses can struggle with palliative sedation because it can hasten death. The reason palliative sedation is ethically ok is due to the intent one has while administering it. The nurse must remember their intension is to promote comfort, but with that death may occur. In order for nurses to continue on and maintain their own stability, they have to remember someone always has to give the last dose of a drug, and they need to remember the good they did for the patient. If a patient dies shortly after a dose of medication you gave, you did not kill them, you simply gave the last dose and the person died because they were ready for one reason or another. Nurses who maintain this sedation for patients are relieving them of suffering and unbearable pain. Doing this for them is not only what the patient wants, but it also restores quality into their life.
Families need to understand the same things that nurses do. They need to know the intention is to relieve pain, which can not be relieved by any other method. Families should be comforted by knowing palliative sedation is freeing the patient of pain.
With this bit of information on palliative sedation, I hope people are more aware and have a better understanding of what it is and how it is useful to patients. This knowledge should be used to free caregivers of the burden they may feel from administering it. This should also free family members of any burden they may feel by choosing to have someone close to them sedated. No one wants to suffer and thanks to palliative sedation no one has to.

1 comment:

Daniel Goldberg said...

As someone with a serious and committed interest in pain management, palliative sedation is obviously an important topic for me, so I'm grateful to you for raising it in this forum.

I think that a much better job needs to be done -- by the media, bioethicists, nurses, physicians, etc. -- of carefully disentangling notions of euthanasia from palliative sedation. The formal philosophical doctrine on which the distinction is based is, of course, the principle of double effect, and understanding it has helped me to gain some insight on the distinction.

The reason I think this is so important is because if one is able to explain why palliative sedation is utterly conventional (in terms of clinical practice, not conventional for the patients and families, of course!), one might be able to get somewhere in terms of pain management without invoking all of the understandable concerns about euthanasia (not saying these concerns aren't relevant, only that they are not equivalent to palliative sedation).

My understanding is that palliative sedation goes on every day in clinical settings all over the country, and I think the reason this is generally accepted, if not widely discussed, is because there is something of the principle of double effect that is kind of present in Western cultural heritage. That's not the only reason, but I find that most people I speak with about the principle seem to grasp it pretty quickly, and say that it tends to confirm their prior intuitions.

All of the above JMO.