End-of-life options: Pain and symptom management and palliative sedation

News & Updates | May 3, 2024 | Dying With Dignity Canada

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At Dying With Dignity Canada, we believe that everyone should know their rights as a patient, understand the various treatment options for which they may be eligible, and record their wishes in an Advance Care Plan. We interviewed Dr. Hayden Rubensohn to help us understand specific options available to us within the health care system. 

Pain and symptom management seems like a very broad topic for a variety of conditions and circumstances. In the health care setting, how is it handled and administered? 

Pain and symptom management take place in five locations: hospital-based palliative care units, hospital-based consultation services, hospices, outpatient clinics, community settings (i.e. in the home). Pain and symptom management should be thought about and attended to for all people with all conditions. 

We sometimes hear about situations where pain cannot be managed, why is this? What options does a patient have if their pain cannot be managed? 

Pain is influenced by psychological, social, and existential factors. Sometimes pain is difficult to control because these other non-physical domains are impacted by illness as well. Sometimes pain isn’t responsive to conventional pain meds, or the pain meds are not tolerated well. There are lots of various modalities to manage complex pain, but I tell all of my patients that if they’re truly suffering, then palliative sedation therapy or MAID are options. 

What is palliative sedation? 

Palliative sedation therapy is essentially the induction of a deeply sedated state that impairs any perceptual awareness of suffering. This state of sedation is maintained until the patient dies naturally. Palliative sedation therapy is understood to not shorten a person’s life. 

When would a patient be eligible for this procedure? 

It is widely understood to only be an option for people whose suffering cannot be relieved by any other means, and if the patient has a prognosis of two weeks or less. 

Is palliative sedation common in the health care setting? 

Palliative sedation therapy is relatively common. It is used if a patient chooses to stop life support or high intensity oxygen support to prevent discomfort. It is commonly used for a condition called terminal delirium, which is a state of agitation or confusion that occurs in the days before end of life.  

Would palliative sedation be a good alternative for someone who does not want or support medical assistance in dying? 

Palliative sedation has broad approval because it is not felt to shorten the patient’s lifespan. It is definitely an alternative to MAID but comes with its own set of strict criteria that must be met before it can be offered. 

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