Refractory Pain, Existential Suffering, and Palliative Care: Releasing an Unbearable Lightness of Being
Author(s)Smith, George P
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AbstractSince the beginning of the hospice movement in 1967, “total pain management” has been the declared goal of hospice care. Palliating the whole person’s physical, psycho-social, and spiritual states or conditions are central to managing pain which induces suffering. At the end-stage of life, an inextricable component of an ethics of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. This Article urges wider consideration and use of terminal sedation, or sedation until death, as efficacious palliative treatment and as a reasonable medical procedure in order to safeguard a “right” to a dignified death. Once a human right to avoid refractory pain of whatever nature in end-stage illness is established by the state, a co-ordinate responsibility must be assumed by health care providers to make medical judgments consistent with preserving the best interests of a patient’s quality of life by alleviating suffering. The principle of medical futility is the preferred construct for implementing this professional responsibility. Rather than continuing to be mired in the vexatious quagmire of the doctrine of double effect—all in an effort to “test” whether end-stage decisions by health care providers are licit or illicit—a relatively simple test of proportionality, or cost-benefit analysis, is proffered. Imbedded, necessarily, in this equation is the humane virtue of compassion, charity, mercy or agape. Assertions of state interest to safeguard public morality by restricting intimate associational freedoms to accelerate death in a terminal illness, are suspicious if indeed, not invalid. No individual should be forced to live when, in a futile medical condition, he or she is suffering from intractable somatic and/or non somatic pain.