Dear Barbara, Will you discuss palliative sedation?
Palliative sedation is a term used by hospice, palliative care, and medical professionals to describe giving large doses of sleep-inducing medications to induce unconsciousness. It is a pain management technique used when all other pain management options have been unsuccessful. It is not routinely used. I would even say it is seldom used.
The National Cancer Institute defines palliative sedation as: “The use of special drugs called sedatives to relieve extreme suffering by making a patient calm, unaware, or unconscious. This may be done for patients who have symptoms that cannot be controlled with other treatments. Palliative sedation may be used in patients who are near the end of life to make them more comfortable. It is not meant to shorten life or cause death.”
I found many other definitions (I love the internet), but this one was the easiest to understand and said what the others were saying but in much less technical detail.
When the terminal illness, the disease progression, has been a pain-filled experience and all comfort management options have been unsuccessful, then sleep is our friend. Sleep, created by regulated, supervised medications, is a compassionate alternative to uncontrollable suffering.
Covid taught us the benefit of “putting a person to sleep” as their body heals. That same technique can also be used as end of life approaches. Not to accelerate the end of life process, but to provide comfort until death comes.
Something More… about Using Palliative Sedation At End of Life
With today’s medical advancements there is no reason for a person to die in uncontrolled pain. If we are in extreme pain and suffering we cannot relax and peacefully leave our bodies. Reading Pain At End of Life helps families understand all the ways that a hospice team can ease pain with the dying.
16 comments
As a hospital chaplain of many years, I have been involved with the valuable, helpful, and appropriate use of palliative sedation. Too often, however, providers are extremely hesitant to apply this needed tool - both hospital and hospice care. Complicating the appropriate application of this resource is the tendency of some hospices, too many hospices, not providing in-home IV medication.
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BK Books replied:
David, I’m a bit confused by your reference to " in home IV medications". Palliative Sedation does not have to be given IV. It is not a specific drug or amount. It is individual, selective medication depending upon each situation. Blessings to you in the work you are doing. Barbara
Hi my husband passed from lung cancer hospice had ordered the meds but he passed peacefully before they came. I wasn’t to sure about giving him the meds because he was already taking morphine and oxycodone for pain. I went to the bathroom and he was gone when I got back.
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BK Books replied:
Hi Dawn, It seems like he gave you a gift of not having to feel you did anything to speed his dying. Blessing! Barbara
“Personal autonomy” means that each of us gets to choose for herself or himself. I understand that this option might not feel acceptable to some people (though until we have firsthand experience with intolerable suffering, we don’t really know what choices we might make). I do know that I would not want another person to have the power to decline this comfort measure on my behalf, if I needed it.
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BK Books replied:
Hi Cindy, this is why we all need to have an Advanced Directive, preferably before we need it. Blessings! Barbara
I am a hospice nurse, and I just want to thank you for your devotion to educating about end of life care and hospice. There are so many misperceptions about what hospice does for patients and their families. It’s very frustrating to read the negative comments here because it is evident that the patient being free of pain and at peace at end of life is not the goal of their families. It seems like many times those involved forget that the patient is our top priority. I will always advocate for my patient because they will always be my top priority!
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BK Books replied:
Hi Julie, thank you for your comment. I’m not sure that the families don’t want their special person comfortable and pain free. They just don’t understand what it takes to get them there. AND that’s where we educators come in. As you and I know 90% of our work is education. Blessings to you in the work you are doing. Barbara
I am a hospice nurse, and I just want to thank you for your devotion to educating about end of life care and hospice. There are so many misperceptions about what hospice does for patients and their families. It’s very frustrating to read the negative comments here because it is evident that the patient being free of pain and at peace at end of life is not the goal of their families. It seems like many times those involved forget that the patient is our top priority. I will always advocate for my patient because they will always be my top priority!
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