Assignment: Integral To Successful Implementation

Pain Management/Terminal Sedation

Assignment: Integral To Successful Implementation

Terminal sedation is used in end-of-life care to relieve severe suffering. It refers to the use

of medications to induce decreased or absent consciousness to the extent that the patient

will no longer feel pain, air hunger or other forms of distress (Kahn et al. 2003; Olsen et al.

2010). In the practice of euthanasia, a lethal injection is administered in an amount that is

certain to bring about and ultimately intended to cause the death of the patient, while

terminal sedation differs from euthanasia in that the dose of medication is maintained

rather than increased once sedation is achieved; the intent being not to hasten death but to

124 J Relig Health (2016) 55:119–134

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relieve suffering (Kahn et al. 2003). Several ethical concerns have been raised, particularly

on the unknown effect that terminal sedation may have on hastening death, and the

potential abuse of patients who are rendered unconscious during the process, in which right

to autonomy is inhibited (Centre for Bioethics 2005; Kahn et al. 2003).

On the risk of exposing patients to a premature death, two major arguments have been

forwarded to justify and dispel this notion: firstly being the doctrine of double effect. The

double effect doctrine, as applied in medicine, is based on two basic presuppositions: the

doctor’s motivation is to ease suffering, and the treatment must be proportional to the

illness (Malik 2012). The doctrine applies if (1) the desired outcome is judged to be good,

e.g. relief of suffering and is not in itself immoral; (2) the bad outcome, e.g. death of

patient is not intended even if it is foreseen; (3) the good outcome is not achieved by means

of the bad; and (4) the good outcome outweighs the bad (Malik 2012; Markwell 2005).

Secondly, it has been argued that the fear that palliative sedation hastens the dying process

is unfounded since studies have shown that sedatives administered appropriately and

proportionately are able to prolong the chances of survival and improve the quality of life

(Centre for Bioethics 2005; Olsen et al. 2010; Tallon 2012).

Further, the effects of pain management also give rise to ethical dilemmas in terms of

the patient’s cognitive perceptions. Since critically ill patients who are sedated are put

into a state of reduced consciousness, this results in the loss of their social interaction.

This not only hampers their ability to effectively communicate and partake in any further

decision-making process regarding their medical care, but also affects the emotional state

of their loved ones. The idea of being put into a deep sleep may not be well tolerated

with certain patients and their families whose spiritual belief includes that one should

face death with a clear, alert and unclouded state of mind (Keown 2005; Zahedi et al.

2007).

Religious and Spiritual Considerations in End-of-Life Care

In end-of-life care, religion and religious traditions serve two primary functions, namely

the provision of a set of core beliefs about life events and the establishment of an ethical

foundation for clinical decision-making (Daaleman 2000). Spirituality, on the other hand,

revolves around a sense and purpose of life, which may not necessarily involve religious

beliefs and practices. Both religion and spirituality support a person’s sense of security

and belonging, and can be especially significant in end-of-life care, offering the patient a

way to find meaning in dying as in life (Chater and Tsai 2008; Daaleman 2000; Mazanec

and Tyler 2003). Clinical assessments on quality of life involve the examination of how

a patient’s illness and well-being are influenced by the patient’s physical, social and

psychological conditions (Tallon 2012). Thus, the inclusion of measures of religiousness

and spirituality into such framework will enable doctors to have a better understanding

of patients’ beliefs, values, expectations and needs and at the same time facilitate a

dynamic interaction between patients, family members and healthcare professionals.

Religion and spirituality can potentially mediate quality of life by enhancing a patient’s

well-being through social support, stress and coping strategies (Daaleman 2000). The

following paragraphs outline the different ethical considerations relating to end-of-life

care from the Roman Catholic, Jewish, Buddhist and Islamic perspectives in issues such

as sanctity of life, withholding and withdrawing of medical interventions and pain