The study shows cancer had spread everywhere, from her colon to her spine, her liver, her adrenal glands and one of her lungs. Eventually, it penetrated her brain. No medication made the pain bearable. A woman who had been generous and good-humored turned into someone hardly recognizable to her loving family: paranoid, snarling, violent.
California’s aid-in-dying law, authorizing doctors to prescribe lethal drugs to certain terminally ill patients, was still two years from going into effect in 2016. But Ms. Martin did have one alternative to the agonizing death she feared: palliative sedation.
Under palliative sedation, a doctor gives a terminally ill patient enough sedatives to induce unconsciousness. The goal is to reduce or eliminate suffering, but in many cases, the patient dies without regaining consciousness.
They believe that any doctor who treats terminally ill patients must consider palliative sedation. If you are going to practice palliative care, you have to practice some sedation because of the overwhelming physical suffering of some patients under your charge.
The boundary between aid-in-dying and palliative sedation is fuzzy, gray and conflated. In both cases, the goal is to relieve suffering. But many doctors who use palliative sedation say the bright line that distinguishes palliative sedation from euthanasia, including aid-in-dying, is intent.
Some people believe they are the same. The goal of aid-in-dying is to be dead; that is the patient’s goal. The goal in palliative sedation is to manage intractable symptoms, maybe through reduction of consciousness or complete unconsciousness.
Sometimes that means a light unconsciousness, in which the patient may still be somewhat aware of the presence of others. On other occasions, it might mean a deep unconsciousness, not unlike a coma. In some cases, the palliative sedation is limited; in others, it continues until death.
Whether palliative sedation hastens, death remains an open question. Pain-management doctors say sedation slows breathing and lowers blood pressure and heart rates to potentially dangerous levels.
There is widespread agreement that palliative sedation is appropriate for intractable physical pain, extreme nausea, and vomiting when other treatments have failed. Terminally ill patients who took their own lives under Oregon’s aid-in-dying law were far less likely to cite physical pain than psychosocial reasons such as loss of autonomy, loss of dignity or being a burden on loved ones.
Palliative Care Is Legal
Using palliative sedation to relieve existential suffering is less common in the United States than it is in other Western countries. In states where aid-in-dying is legal, terminally ill patients rarely choose between aid-in-dying and palliative sedation. They also must be healthy enough to take the legal drugs themselves.
Whether palliative sedation truly ends suffering is not knowable, although doctors perceive indications that it does. Palliative sedation is slow-motion aid-in-dying. It was better than being awake and suffocating, but it was not a good alternative.