Pain Issues With the Dying Process

Pain Issues With the Dying Process

Palliative care for the terminally ill has spurred multiple analyses of the Nursing Profession's commitment to relieve pain endured by terminally ill patients. Though intently examining numerable aspects of palliative care, the most of the literature shows a logical gap in its apparent assumption that medication hastens death. Some healthcare professionals have challenged that assumption, undertaking studies of carefully assembled data from groups of terminally ill patients and have found that palliative care is not the "slow euthanasia" evidently inferred by most medical theorists.

"Pain Assessment and Management in Palliative Care" by Nessa Coyle and Mary Layman-Goldstein (Coyle & Layman-Goldstein, 2001), discussing AACN capacities in the assessment and treatment of pain, particularly in peri-death treatment;

b. "Symptoms and Attitudes of 100 Consecutive Patients Admitted to an Acute Hospice/Palliative Care Unit" by K. Ng and C.F. Gunten (Ng & Gunten, 1998), reporting the results of a study assessing physical symptoms and attitudes of 100 U.S. patients admitted to a teaching hospital from June 1995 and October 1995;

c. "Family Support in Advanced Cancer" by B.A. Given, et al. (Given, 2001), discussing the advantages of treating the family healthcare giver as part of a team for treatment, including assessing and treating pain issues;

d. "Emotional Problems in the Family" by Joan T. Panke and Betty R. Ferrell (Panke & Ferrell, 2005), stressing the importance of educating the patient's family on assessing and managing the patient's pain;

e. "An Understanding of Suffering Grounded in Clinical Practice and Research" by David L. Kahn and Richard H. Steeves (Kahn & Steeves, 1996), discussing the fact that terminal suffering possesses a new meaning for the patient, as his/her previous experiences of pain are no longer applicable;

f. "Peri-Death Nursing Care" by Marianne L. Matzo (Matzo, 2001), addressing the importance of providing comfort with the last 2 days of life;

g. "Responding to Intractable Terminal Suffering: the Role of Terminal Sedation and Voluntary Refusal of Food and Fluids" by Timothy E. Quill and Ira R. Byock (Quill & Byock, 2000), analyzing terminal sedation and voluntary refusal of food/fluids as possible last resorts to meet the needs of patients who wish to hasten death due to unacceptably severe pain;

h. "Slow Euthanasia" by J.A. Billings and S.D. Block (Billings & Block, 1996), which takes the position that palliative medication equals slow euthanasia of the patient.

The articles/chapters cover various aspects of palliative medications for terminally ill patients; therefore, each article/chapter cannot be expected to cover all possible facets of pain issues in the dying process. However, all the articles/chapters appear to assume that pain medications will shorten life while enhancing the quality of life. The gap in all this literature is the assumption that comfort from administering pain medications to terminally ill patients is achieved at the expense of the patients' shortened lifespans.

Addressing the logical gap of the above articles/chapters is "Palliative Sedation, Not Slow Euthanasia: A Prospective, Longitudinal Study of Sedation in Flemish Palliative Care Units" by Patricia Claessens and Bert Broeckart (Claessens & Broeckaert, 2011). Based on data accumulated from 266 cancer patients in 8 palliative care units, the study's aim was to record the characteristics of terminal patients sedated for refractory symptoms from their admissions until their deaths. Claessens and Broeckart found that all the studied patients were in the end stages of their illnesses and required complete care but were fully conscious upon admission. Approximately 7.5% of the patients reported about two refractory symptoms such as "pain, fatigue, depression, drowsiness, and loss of feeling of well-being" (Claessens & Broeckaert, 2011, p. 16). All patients reporting these symptoms consented to palliative medication treatment, which commenced 2.5+/- days before their deaths (Claessens & Broeckaert, 2011, p. 18). After collecting and analyzing the data, Claessens' and Broeckart's conclusions included the data-support argument that palliative sedation does not shorten the lifespan of terminally ill patients (Claessens & Broeckaert, 2011, p. 22).