Patients with symptoms of severe pain or shortness of breath will often ask me: “if my treatments are not controlling my symptoms, what can be done so I won’t suffer when death approaches.”
The goal of medicine has always been to provide comfort and prevent or relieve suffering; this means we have an obligation to ensure that people die peacefully, with dignity. No one wants to watch a loved one struggle at the end of life.To achieve that goal, sometimes the only way we can control symptoms is to induce a state of sleep or unconsciousness, called “Palliative Sedation”.
This sedation can be a temporary or permanent light-to-deep sleep. Drugs, such as phenobarbital, are given when extraordinary doses of others are not helping. This may cause a light sleep which gives respite from the symptom, allowing the patient to waken after a few hours and hopefully be improved. Unfortunately, that often doesn’t occur and so the ‘light’ sleep or even a deeper unconsciousness is necessary and is maintained, as an “option of last resort”, until death occurs.
Ethically, this is known as the Principle of Double Effect: the intent is to provide comfort, but the treatment may result in the unintended consequence of death. The US Supreme Court sanctioned this in 1997.
Suffering is intensely personal and patients want some assurance that we will not let that happen if a crisis occurs: Palliative Sedation is available if they need it.