Suffering

Question 1

Existential (ambition, meaning of life, dignity) pain/ suffering

Answer 1

“The meaning of life differs from man to man, from day to day and from hour to hour. “What matters therefore”, is not the meaning of life in general but rather the specific meaning of a person’s life at a given moment”

Question 2

refractory/intractable symptom

Answer 2

• Aggressive efforts short of sedation fail to provide relief.
• Additional invasive/non-invasive treatments are incapable of providing relief.
• Additional therapies are associated with excessive/unacceptable morbidity, or are unlikely to provide relief with a reasonable time frame.

Question 3

The doctrine of
double effect

‘‘It is widely recognized that the provision of pain medication is ethically and professionally acceptable even when the treatment may hasten the patient’s death if the medication is intended to alleviate pain and severe discomfort, not to cause death”

Answer 3

• It’s about INTENTION;
• a set of conditions which use for evaluating the permissibility of acting when one’s otherwise legitimate act (relieving a terminally ill patient’s pain) will also cause an effect one would normally be obliged to avoid (for example, the patient’s death).

The doctrine consists of four conditions that must be satisfied before an act is morally permissible:

• The nature-of-the-act condition. The action must be either morally good or indifferent.
• The means-end condition. The bad effect must not be the means by which one achieves the good effect.
• The right-intention condition. The intention must be the achieving of only the good effect, with the bad effect being only an unintended side effect.
• The proportionality condition. The good effect must be at least equivalent in importance to the bad effect.

Question 4

Palliative sedation

Answer 4

“The relief of refractory, intolerable suffering by a reduction in conciousness which determined by the patient or the caregivers.”

• Use after ALL options exhausted
• Resevere for the LAST hours of life
• Psychological assessment by a skilled clinician.
• Spiritual assessment by a skilled clinician or clergy.
• A DNR/DNI order must be in effect and informed consent obtained and documented.
• Level of sedation needs to be discussed.
• Nutrition/hydration issues need to be addressed prior to sedation.

Question 5

Respite Sedation

Answer 5

A time limited trial (usually 24-48 hours) in an attempt to break a cycle of psychological suffering.

Question 6

Physician assisted suicide

Answer 6

Physician written prescription for patient to take, INTENT/ GOAL is death

Question 7

Euthanasia

Answer 7

Physician administers the medications and GOALS is death AND physician is THERE to GIVE medications.

Question 8

What are the common REASONs for palliative sedation?

Answer 8

1. Delirium (30%)
2. Psychological distress (19%)
3. Dyspnea (14%)
4. Pain (7%)
5. Vomiting (3%)

Question 9

Does Palliative sedation hastening death?

Answer 9

NO

• 7 to 36.5 (intervention gr) vs 4 to 39.5

Question 10

Efficacy, side-effect

Answer 10

• 71% to 92% sucess rate
• 78% family satisfied but decision making process is burdensome (30%)
• Take 60mins to 48hours to achieve goal
• Midazolam is commonly used
• 22% developed complication: respiratory depression, paradoxical agitation, aspiration