Palliative sedation: Why we should be more concerned about the risks that patients experience an uncomfortable death

Palliative sedation is still controversial and many papers are dealing with the ethical aspects of it. However, we were struck by the fact that palliative sedation, as a practice to assure a painless death, is based on several unproven and doubtful premises. A critical evaluation based on more recent evidence raises the question whether the current assessments of suffering and awareness are accurate enough.

In recent years, new studies based on innovative methods in the field of neuroimaging revealed some surprising results, e.g. with regard to patients who are mistakenly considered unaware. We were also surprised that innovative methods to detect pain and awareness, such as fMRI or EEG, have, up till now, not been used to check whether dying sedated patients experience distress.

In our paper we raise several points of concerns with regard to assessment of suffering and discomfort in dying patients but we also propose a relatively simple method to check the common assessment tools for pain and distress these patients. This may lead to a more objective and accurate assessment tool than the subjective assessments by caregivers.