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Terminal sedation is a form of palliative care offered to patients who are close to death and experiencing considerable pain. In this type of sedation, also known as palliative sedation, the patient is given a heavy dose of sedatives and pain management drugs so that he or she is no longer conscious and experiencing pain. This practice is controversial in some regions, and it has attracted some very heated debate from a wide variety of perspectives.
Ideally, terminal sedation is initiated after a discussion with the patient or after reading a patient's advance directives. In addition to offering sedation, the care provider may provide intravenous fluids and nutrition to increase patient comfort, and additional lifesaving measures may be taken as well. Terminal sedation is offered in the last hours or days of a patient's life, and only if the patient is in intractable pain which cannot be managed by other means. Once the patient has been sedated, the medical team and family members make decisions on the patient's behalf, since he or she will not be able to communicate.
While a patient is under terminal sedation, he or she must be closely monitored, because sedatives can depress respiration and heart rate. The drugs must be administered and managed with care, so that the sedation does not cross the line into euthanasia. Some medical ethicists have expressed concerns about the fact that terminal sedation could potentially be used to kill or euthanize patients, especially in the case of patients who may not have advocates to speak up for them.
Some medical conditions can cause extreme pain and suffering. An ironic consequence of increasing sophistication in medical care has led to situations in which patients may live far longer than they would like to, sometimes experiencing considerable pain and misery in the process. This type of sedation is viewed as an option for patients who would prefer to be unconscious in their last hours, and it may be discussed with patients and family members in a review of hospice care options.
Palliative sedation is legal in most nations, with a clear distinction being made between terminal sedation and physician-assisted suicide. However, ethics investigations have uncovered cases in which terminal sedation has been used to effectively kill patients, or in which it has been used on patients who were not able to make an active choice to opt for terminal sedation. This rings alarm bells for many patients rights advocates, who want to ensure that people are allowed to make their own choices about medical care and treatment options.
Why would we continue giving food and water by tubes
when the life-ending decision has already been made? When the patient is continuously unconscious, what benefit can come from continuing to provide fluids by tubes? Terminal sedation is clearly a life-ending decision. The patient will be kept unconscious until death.
When my mother was dying, she hadn't had any food for two weeks; all she had in the hospital was IV fluids. ECGs made it apparent that she was disconnected from all but the basic survival parts of her brain.
When I took her home to die, I requested some liquid morphine in case I couldn't soothe her pain by other means. The doctor said that if she could take things by mouth I had to feed her. It would have been excruciating for her to restart her digestive system. Articles on starvation/fasting make this clear.
I was also told that the morphine would depress her respirations; this seemed largely irrelevant since she was obviously going to die within a
short time period.
Since she and I had many talks over the years about what she would want in this situation, I was totally comfortable with giving her the medication. One of the things that might occur in dying patients is the horrible feeling of suffocation, and one of the few medications which relieves this is morphine.
While many may disagree with my actions and decisions, I gave my mother the care that she wanted; she did not die because of the morphine.
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