The term "symptom" conventionally connotes a physical malady,
such as pain or dyspnea. However, it is acknowledged (Cherny
1994) that psychological symptoms like anxiety, panic and existential
issues can also result in intractable suffering. Clinicians must be cognizant
that suffering from existential anguish can be just as significant and
distressful as refractory physical symptoms, thus endorsing consideration
of palliative sedation in refractory cases (Rousseau
2000).
Palliative sedation for psychological or existential suffering is ethically
and morally more problematic than is sedation for physical suffering.
Reasons for this is as follows:
The lack of standardized clinical and psychological assessments for
existential distress, particularly during the dying process, when overwhelming
and demoralizing losses are exceedingly prevalent.
Patients with existential distress may also be awake, alert, and
without obvious physical symptoms, further confounding and complicating
the decision to utilize palliative sedation.
If palliative sedation is considered for existential suffering, untreated
depression, delirium, anxiety, and familial discord must be distinguished
from tangible refractory existential distress, and ethics and psychiatric
consultations should be considered.
Different health care systems may have different rules governing the
sensitive issue of palliative sedation for psychological or existential
suffering.
Department of Veterans Affairs position on
palliative sedation for intractable psychological and existential
suffering:
Permitted
Palliative sedation is permitted in terminally
ill patients for alleviation of refractory physical symptoms.
Instituting palliative sedation for alleviation non-physical
refractory symptoms is contraindicated in all VA facilities.
Click here for a 2006 document detailing the Department of Veterans Affairs position on palliative sedation
