Palliative sedation

Nurse: So, this is your first internship in palliative care, isn’t it? What do you know about care in the palliative service?

Trainee: Well, as far as I know, it’s specialized medical care for people with serious illness. But I don’t know exactly what we do!

Nurse: We focus on providing relief from the symptoms and stress of the illness. The goal is to improve the quality of life for both the patient and the family.

Trainee: And how is a trainee supposed to participate in this kind of care?

Nurse: You have first to know that palliative care is provided by a specially-trained team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide extra support.

Trainee: But then, what’s the point of doing so for old patients who are almost dying?

Nurse: Common knowledge only attributes palliative care to old patients, but it’s appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.

Trainee: But then again you mentioned that it’s for improving the patient’s quality of life. In what cases do we propose palliative care?

Nurse: Palliative care teams specialize in treating people suffering from serious illnesses such as cancer, congestive heart failure, chronic obstructive pulmonary disease, kidney disease, amyotrophic lateral sclerosis, but also Alzheimer’s and Parkinson’s.

Trainee: And what symptoms do we exactly deal with?

Nurse: This type of care treats pain, depression, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping, anxiety and any other symptoms that may be causing distress. The team will help the patient gain the strength to carry on with daily life. And in addition to treating the symptoms, the palliative care team spends as much time as possible communicating with the patient and his family. Trainee: But what if the patient is declared as anyway dying soon?

Nurse: This is where the option of palliative sedation comes in. Do you know anything about that?

Trainee: I guess it’s like the use of special sedatives to relieve extreme suffering by making a patient calm, unaware, or unconscious. But I find this unethical!

Nurse: Oh, it’s not at all meant to shorten life or cause death. It’s regarded as the use of sedation until death in the terminal phase for intractable symptoms. The decision to administer palliative sedation is never taken lightly, and is considered only as the last resort once all other measures have been exhausted. Trainee: And how can this be decided?

Nurse: Establishing that a symptom is impossible to control is the first step in this process, and it is important that the decision is made by doctors and healthcare providers within the multidisciplinary team. This can only be done in the context of the clear and informed consent of the patient or the family. Palliative sedation does not directly end life, although some take palliative sedation and euthanasia for the same.