Palliative Sedation Therapy
What is Palliative Sedation Therapy?
Palliative Sedation Therapy is a widely accepted medication technique used as an effective way to bring relief to those who are suffering from very hard-to-control physical or psychological symptoms that may occur at the end of life. These symptoms are sometimes called “refractory symptoms” or “intractable symptoms”.
The intent of Palliative Sedation Therapy is to reduce the level of consciousness to relieve the burden of suffering, NOT to hasten death, using the lowest dose to achieve comfort.
Why Palliative Sedation Therapy?
Symptom relief is one of the main goals of palliative medicine.
In rare cases at end-of-life, symptoms of intolerable suffering cannot be controlled. In these severe cases, all reasonable efforts to manage these symptoms have been tried and failed.
The palliative care team can provide medications to reduce the level of consciousness, allowing the client to become unaware of their suffering.
When is Palliative Sedation Therapy Considered?
It takes great courage to cope with a loss and begin to embrace life again. Grief does not go away; rather it becomes integrated into your daily life. For many people, the grieving process can last for weeks, months or even years. Your grief will evolve and change over time, often becoming more manageable as you move forward on the path to healing. Some signs of healing are:
- Suffering is unbearable for the client
- Natural death from illness is imminent
- Client/alternate decision maker must provide consent
- The primary care provider has confirmed that all reasonable efforts to control suffering have been tried and unsuccessful in relieving symptoms
- Aligns with the client’s goals of care
Common examples may include but are not limited to:
- Awareness of overwhelming pain
- Agitation, confusion, delirium
- Severe seizures that will not stop
- Severe breathlessness
- Fear of dying or the unknown
- Any intolerable physical, psychological, emotional, or spiritual symptoms experienced during the dying process
How Can Family/Alternate Decision Maker Provide Support?
- Have goals of care discussions with your loved one
- Discuss palliative sedation therapy with your loved one and the palliative care team
- Share meaningful discussions, reflect upon memories, friendships, thoughts and beliefs, share comfortable silence
- Advocate should they no longer be able to advocate for themselves
- Provide comfort through presence, gentle touch and soft-spoken words
Dying Person’s Bill of Rights
- I have the right to be treated as a living human being until I die.
- I have the right to maintain a sense of hopefulness, however changing its focus may be.
- I have the right to be cared for by those who can maintain hopefulness, however changing its focus may be.
- I have the right to express my feelings and emotions about my approaching death in my own way.
- I have the right to participate in decisions concerning my care.
- I have the right to expect continuing medical and nursing attention even though “cure” goals must be changed to “comfort” goals.
- I have the right to not die alone.
- I have the right to be free from pain.
- I have the right to have my questions answered honestly.
- I have the right not to be deceived.
- I have the right to die in peace and with dignity.
- I have the right to retain my individuality and not be judged for my decisions, which may be contrary to the beliefs of others.
- I have the right to expect that the sanctity of the human body will be respected after death.
- I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death.
Source: The “Bill of Rights” was created at a workshop “The Terminally Ill Patient and the Helping Person” in Lansing, Michigan sponsored by the South Western Michigan Inservice Education Council and conducted by Amelia Barbus (1985), Associate Professor of Nursing, Wayne State University.