Every palliative care worker has come across this situation: The patient is in intolerable pain (or breathlessness or agitation) and despite all you do, continues to be so. You look up Oxford Textbook of Palliative Medicine; you google all over the cyber world; yet there is no solution in sight. The patient is in agony; the family is in agony.
Yes; this happens. Palliative care professionals are only human beings. They can get rid of much of the suffering; but not all the time.
When everything fails (refractory symptoms, if you want to get technical) and the patient is near the end of life, we discuss within the team; we discuss with the patient if he is competent to understand and take decisions, we discuss with the family, and with consensus, provide deep sedation to relieve the “intolerable suffering”.
The objective is to relieve symptoms, not to cause death. And this is not something that a palliative care team does every day; this is an exceptional situation.
Read the article titled Reflections on Palliative Sedation by the master, Dr Robert Twycross, on the latest on this ethical dilemma/imperative.