Compassion & Choices helped to legitimize palliative sedation as a recognized medical practice by advancing the court case that recognized dying patients have a constitutional right to receive as much pain medication as necessary, even if it advances the time of death, in the U.S. Supreme Court decision Vacco v. Quill (1997).
What Is Palliative Sedation?
Palliative sedation (also called terminal and total sedation or continuous deep sedation) involves being medicated to reduce consciousness. Typically, the person remains unconscious until death. At the same time, all nutrition and fluids are stopped. Sedation may bring some relief for extreme pain and suffering. However, it may not totally relieve symptoms.
Most symptoms at the end of life can be treated well and patients can be kept comfortable with pain medication and sedatives. However, some patients experience continuous pain, agitation, delirium and restlessness that cannot be adequately treated. For these people, palliative sedation is an option to relieve their suffering.
Is This the Same As Simply Increasing the Dosage of Pain Medication?
No. For some patients, increasing the dosage or frequency of pain medications will make them very tired, and they may sleep most of the day but can be roused. When a person receives palliative sedation they are more deeply unconscious.
How Does It Work?
Palliative sedation must be medically managed by a healthcare provider. Palliative sedation is ordered by a patient’s provider after carefully evaluating the patient’s symptoms, disease process and prognosis and discussion with the patient and the family/caregivers. The sedating medications can be given to the patient in several ways — most often in an IV (intravenous) or subcutaneously (under the skin). This is most typically done in a hospital or care facility.
Isn’t Palliative Sedation Controversial?
Palliative sedation is now an accepted medical practice. However many healthcare and hospice providers have had little experience with the terminology and procedure involved and may not offer palliative sedation as an option. This is because most symptoms at the end of life can be treated and patients are kept comfortable enough not to require it.
Who Will Decide, and When?
Patients diagnosed with a terminal illness and especially those enrolled in hospice, should have a straightforward conversation with their healthcare provider about the option of palliative sedation, as well as other options. This discussion is best done early when the patient can communicate clearly and understand their options.
Your healthcare team will work with you to determine whether or not palliative sedation is right for you. Some terminally ill patients have found it helpful to have a close friend or family member involved in these discussions as well. This is a difficult decision for some, and the procedure and its outcome need to be made clear to all involved.