Hospice Patients Alliance: Consumer Advocacy


Sedation Sometimes Necessary for Pain Relief

Hospice care is an art as well as a science, just like any aspect of medical and nursing care. When patients are in severe pain due to a terminal disease, the strong medications required to keep them comfortable may have sedative-like effects, placing the patient into sleepy states of awareness, especially in the case of the elderly who cannot metabolize the medication as well as others, or during the first few days patients start to take the medication. While it is possible for some patients to receive extremely high doses of narcotics and remain fully alert, awake and comfortable, some patients are only able to achieve full relief from pain with dosages that make them sleep.

Patient May Prefer Alertness over Pain Relief

The ideal goal in hospice care normally is to keep the patient as comfortable as possible. In those cases where the patient experiences strong sedative effects of the medications, some patients will accept sleep and comfort as a welcome relief from their suffering. However, in certain other situations, the patient may place more value on remaining totally alert and awake till the very end. The quality of life issue becomes a choice between pain relief and remaining awake and able to communicate with others or be aware of who's there, what's going on and still participate consciously in life.

Those patients who prefer to remain as alert and awake as possible may sometimes refuse narcotic medications, and of course, the hospice and family should respect the patient's wishes. Some patients may refuse pain medications in the belief that pain is a necessary part of death, or that being stoic and not complaining is important. These are all personal decisions for each patient, and families may have other ideas about what should be done. This can be extremely difficult for family, friends and hospice staff to handle. It may be heartbreaking. Most of us prefer to do our best to relieve the pain our loved ones may be experiencing.

Physicians' Practice in Relieving Pain

Physicians vary widely in how they treat pain in the terminally ill. This may be surprising to those who are not well-experienced in dealing with physicians. Some physicians will provide all the relief from pain which medical science can offer. Others refuse to prescribe strong narcotics in dosages which are sufficient to relieve the pain. Hospice philosophy believes in relieving the pain, and condemns those physicians who choose to abandon their patient to his or her suffering without trying their best to relieve that pain.

Some physicians believe in ordering gradually increasing dosages of pain medications until a sufficiently strong and effective dosage is reached. This well-tried and trusted approach, when used in combination with anti-anxiety or sedative medications, can be a very effective combination which helps the patient achieve the highest level of pain control and still remain as calm and alert as possible.

Still other physicians may go overboard in treating the pain of the terminally ill...they believe they are "God" and decide to put the patient out of their misery, putting the patient "to sleep" permanently. Those physicians who unilaterally choose to overdose their patients are as much to blame as those physicians who under medicate their patients' pain. What should be clearly understood by all patients and families is that there are definite standards of practice about how to treat pain, how to increase dosages, what medications to use, when to begin new medications if previous medications have been ineffective, and so on.

Medical science is very capable of relieving pain in the terminally ill. It is sometimes the unwillingness of the physician (to provide medications which are effective in dosages sufficient to relieve the pain) which is the real reason so many dying patients' pain is unrelieved. In so many cases, the terrible suffering is unnecessary.

Death does not have to be painful. Good hospice care under the direction of a competent physician who knows how to treat pain will effectively relieve the pain in most patients. Sometimes palliative use of chemotherapy or radiation may be necessary. Sometimes surgery may need to be done for pain relief. Sometimes one or more medications knowledgeably administered will be all that is necessary to relieve the pain. Relieving pain is crucial to your loved one's quality of life! The most important factor in achieving pain control is having the right physician who is willing and able to order the treatments or medications necessary to bring comfort to your loved one. If pain is relieved, the dying process can be a peaceful, calm transition with family members expressing their love and support throughout.

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