Terminal Sedation

For persons in extreme pain, terminal sedation—medications that induce sleep until death occurs—may ease suffering as the dying process runs its course.

Thanks to great advances in pain management, many seriously ill and terminally-ill patients can be made comfortable during the final days of an illness. For some, however, suffering may become extreme. While care-teams will always place the most emphasis on moderating discomfort while attempting the best possible quality of life for terminal patients, certain patients may not respond without very high doses of medication. It is in these circumstances where physicians may talk about something called the “double effect” of pain medication, or in rare circumstances, about using terminal sedation. It is hoped that the ill person has discussed what measures should be taken in advance with their health care proxy, or they have stated their wishes in a living will. But to prepare for these discussions, it is important to know what these terms mean

The Double Effect

The “Double effect” has been defined in medical journals as: “the administration of opioids or sedative drugs with the expressed purpose of relieving pain and suffering in a dying patient. The unintended consequence may be that these medications might cause either respiratory depression or in extreme sedation, might cause to hasten a patient’s death.” What does this mean? In the simplest terms it means that the medication required to abate suffering cannot be given without the probable result of hastening death. While this may sound vague and quasi-discomforting, it is a legal, medically accepted practice, as long as the intention is only to relieve suffering and not cause death. The death is attributed to the disease or complications of the disease, combined in some circumstances with the withdrawal of life-sustaining treatments such as intravenous liquids, nutrition, and artificial respiration. While the patient need not be unconscious during this process, unconsciousness is often the result

Terminal Sedation

In rare cases some patients who are very ill do not respond to pain medications or may be suffering in other ways that make comfort impossible. In these circumstances there is a last resort therapy that can be used: terminal sedation. With terminal sedation, a patient will be given medications that induce sleep or unconsciousness until such time as death occurs as a result of the underlying illness or disease. These measures are often accompanied by the withholding of artificial life supports like intravenous feeding and artificial respiration. Like the use of medications that cause a “double effect,” the intention with terminal sedation must be to relieve suffering only, not to cause death.

Reprinted from “Terminal Sedation” by Ann Villet-Lagomarsino. Educational Broadcasting Corporation/Public Affairs Television, Inc. Reprinted with permission.

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