Understanding the Last Resort: Sedation

Take a second to think about the most pain you’ve ever experienced. You know, the kind of pain that puts black spots before your eyes; when you’re teetering on the brink of unconsciousness, and you want to cry and vomit at the same time. Maybe it was a sports injury. Maybe it was a broken knee. Maybe it was childbirth.

Now, consider this: Sedation is only an option in end-of-life care when the pain is way beyond the moments you were just recalling. We’re talking outside the scope of the pain scale. A patient’s pain must be intolerable for sedation to be offered by healthcare providers. “[The pain] is something you almost have to see,” explains Mary Christ, Crossroads Hospice Clinical Director. “It’s almost intangible. We can do an assessment, but [the directive for sedation] has to come from the patient and their actions.”

Sedation is a resource many physicians avoid discussing. There’s a social taboo around it; a misunderstanding that sedation is euthanasia, which is illegal in the United States and to some, unethical. There’s also a medical taboo around it. “Physicians are extremely uncomfortable, and rightly so,” Christ acknowledges. “The amount of medication and doses to be used – that’s when physicians get uncomfortable. They don’t usually use that amount. It’s alarming to them,” says Christ.

But, that’s why “it’s used very rarely,” Christ says. Christ, who’s worked in the healthcare field for more than two decades, has seen the careful consideration given around the use of sedation. “I’ve experienced it once and it went extremely well. The end result was accomplished. It’s what the family wanted.”

Christ, who spends the majority of her days working with other Crossroads Hospice team members to ensure patients are comfortable, dispels several misconceptions about sedation:

• Misconception #1: The end result of sedation is death. “That’s not true,” says Christ “The sedation takes care of the pain control. The disease process causes death.”

• Misconception #2: Sedation is recommended by a palliative physician who may not be familiar with the patient, and may misunderstand a patient’s pain.  The palliative physician and attending physician work in collaboration and each “bring a unique perspective,” Christ explains. “The palliative physician has experience with end-of-life care; the attending physician has a history with a patient. As always, two heads are better than one. If they work together, it makes an incredible team.”

• Misconception #3: Sedation is an option as soon as a patient receives a terminal diagnosis. That’s not at all the case. “What they’re going to look at is: What have we tried [to manage the patient’s pain]?” says Christ. “We start with step therapy. We start at the lowest step and work our way up. If nothing is working, [sedation] will be the last step.”

“Sedation is a last resort. It’s not something we take lightly,” Christ says.

To learn more about sedation, when it’s used, and what it really does, read the National Hospice and Palliative Care Organization’s Position Statement and Commentary on the Use of Palliative Sedation in Imminently Dying Terminally Ill Patients.

For questions about hospice and sedation, please call us at 888-564-3405.

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