It is progression of disease, not sedation that causes the body to reject food and water. Fact: When people are at the very end of life, their bodies are shutting down and unable to absorb and digest food and water. Myth: Palliative sedation promotes dehydration and starvation. Fact: People in a coma-medically induced or natural-do not feel pain. The National Hospice and Palliative Care Organization also offers a statement on palliative sedation. The American Academy of Hospice and Palliative Medicine (AAHPM) has a specific position statement on palliative sedation, including a definition. Multiple protocols and guidelines for medical care during the last hours of living exist on the websites of major health and palliative care organizations and medical journals and textbooks have clear guidelines. Fact: Much has happened in the last six years. Myth: There are no universally accepted protocols for treating people in the last weeks of life. It is used extremely rarely because the vast majority of patients get acceptable relief without sedation. Fact: Palliative sedation is a treatment of last resort when symptom distress cannot be relieved using standard methods. Myth: Palliative sedation is common and widely used. (A bibliography of these articles is available from NHPCO.) Research showing that patients at the very end of life who receive palliative sedation do not die more quickly than patients who are not sedated has been published in such top tier peer reviewed professional journals as Annals of Oncology, Journal of Palliative Medicine, Journal of Pain and Symptom Management, Archives of Internal Medicine, and Palliative Medicine. Studies clearly demonstrate that palliative sedation does not hasten death. Patients with poorly controlled pain, shortness of breath, and agitation actually die sooner because of the stress caused by this suffering. Fact: It is disease progression that causes the body to gradually shut down and eventually die. Glucksberg, 1997) supported the concept of sedation when used to relieve intractable suffering. In the United States, Supreme Court rulings (Vacco v. This is as true with palliative sedation as with any other aspect of medical treatment. Health care providers have a responsibility to do no harm and to relieve suffering. Intractable pain itself, in fact, may hasten death. To the contrary, untreated symptoms such as pain, stress and anxiety lead to worsening strain and exhaustion in patients and family members alike. Studies demonstrate that symptom relief near death does not hasten death.
The fact that dying people require symptom relief does not mean that symptom relief causes death. Treatment of these symptoms is for the purpose of providing relief. It is a fact that many people have distressing symptoms while dying-for example, pain, shortness of breath, nausea, restlessness and agitation. The belief that symptom management hastens death in the dying is a classic example of confusing an association with causation.
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