Most people choose not to think about their own death, and because we avoid the subject, it is hard to know what we might want when confronted by the reality of having to deal with a terminal diagnosis.

Around the world, there is much debate about a person’s  ‘right to die’ with dignity at a time of their choosing by euthanasia, versus access to good quality end of life or palliative care that helps them to live with dignity and as high a ‘quality of life’ as possible, before they die from an incurable illness.We all need to talk more about death being a natural part of life. Maybe then we will be better equipped to enable people who are dying to get the best out of any time they have left.

End of Life/Palliative Care Definition  In medicine, nursing and the allied health professions, end of life or palliative care refers to the health care of people in the final stage of their life, with a terminal condition that has become advanced, progressive and incurable.  It is an approach that improves the quality of life of the person and their families, who are facing the problems associated with a life-threatening illness, through the prevention and relief of suffering by means of treatment of pain and other problems, physical, psychosocial and spiritual.

End of Life/Palliative Care helps them manage their illness, particularly pain and symptoms, so they can continue to live their life as well as they can while dealing with their illness.  Some people may need or want to have palliative care from the beginning of their diagnosis, or they may choose to have it at a later stage of their illness.  It is also possible to have palliative care on an intermittent basis, only during periods of acute or prolonged unwellness.

Palliative sedation, sometimes referred to as terminal sedation, is the progressive use of sedatives to achieve a desired level of comfort for a person in the final stages of life who has unrelieved suffering.  Palliative sedation is only administered to relieve excruciating, unrelieved suffering, and only when a person is already close to death.

Palliative sedation is not euthanasia, nor is it physician-assisted suicide. Essential differences in each one of these terms make them markedly different.

Palliative sedation is never done without the person or their appointed decision maker’s consent, and in consultation with the medical team.  Palliative medication is given and increased, until the desired comfort level is achieved. Often, people are able to maintain consciousness while sedated to a comfortable level, but if a person is still experiencing unbearable symptoms, inducing unconsciousness may be an acceptable last resource.

If inducing an unconscious state is the only way to relieve suffering, it may be tried as an interim solution with the health professionals allowing the sedatives to wear off to reassess the person’s comfort levels. It may then be decided that the only way to ensure comfort is to maintain complete sedation until death occurs.

In contrast to euthanasia and physician-assisted suicide, the intent of palliative sedation is not to cause death, but to relieve suffering.  Death may occur sometime after inducing palliative sedation, but it’s often uncertain if the terminal illness or the sedative medication caused it. Because the primary intention of the sedation was not to end the person’s life but to relieve suffering, it cannot be equated with either euthanasia or physician-assisted suicide.

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