Customize your JAMA Network experience by selecting one or more topics from the list below.
People who are dying of a serious medical condition for which no cure
is available or for which treatments have failed have a terminal illness. These patients can receive comfort care, which focuses
not on life-prolonging measures but on relieving pain and suffering at the
end of life. Palliative care provides comfort care
to the patient by focusing on relieving symptoms such as pain, anxiety, nausea,
and difficulty breathing. Family members as well as the patient are provided
with emotional, social, and spiritual support to help them with the dying
process. Hospice care provides palliative treatment,
often with a team approach, to serve a variety of patient and family needs
such as home nursing care, social services, pain management, and spiritual
support. The October 12, 2005, issue of JAMA includes
an article about palliative sedation.
Terminal illnesses can cause distressing symptoms, such as severe pain,
mental confusion, muscle spasms, feelings of suffocation, and agitation. Despite
skilled palliative care, in some cases these symptoms may not respond to standard
interventions. After all other means to provide comfort and relief to a dying
patient have been tried and are unsuccessful, doctors and patients can consider
palliative sedation. Palliative sedation is the use of sedative medications
to relieve extreme suffering by making the patient unaware and unconscious
(as in a deep sleep) while the disease takes its course, eventually leading
to death. The sedative medication is gradually increased until the patient
is comfortable and able to relax. Palliative sedation is not intended to cause
death or shorten life.
Decisions regarding the end of life are difficult. It is imperative
to maintain open communication between the palliative care team, patient,
and family members. If possible, patients should make their own decisions
about end-of-life care. If a patient is unable to make his or her own decisions
and has no advance directive (documents that state
in advance a patient's end-of-life wishes), a health care
surrogate (someone who is appointed by the patient in advance or who
is appointed to represent the patient) may make decisions based on what the
patient would want.
Patients and their families should feel comfortable discussing their
feelings and what to expect with the palliative care team. Patients should
consider what they want for comfort and discuss their wishes regarding family
good-byes, funeral plans, and religious rituals. It is important to know that
the timing of death is difficult to predict and could be anywhere from hours
to days after palliative sedation is initiated. Although many times these
issues are discussed only when death is near, you should consider discussing
your end-of-life wishes, including palliative care decisions, with family,
friends, and your doctor before a terminal illness occurs.
National Hospice and Palliative Care Organization800/658-8898http://www.caringinfo.org
Hospice Foundation of America800/854-3402http://www.hospicefoundation.org
International Association for Hospice and Palliative Carehttp://www.hospicecare.com
To find this and previous JAMA Patient Pages, go to the Patient Page
link on JAMA's Web site at http://www.jama.com. A previous Patient Page on palliative care was published in the March
16, 2005, issue; one on hospice care in the February 21, 2001, issue; and
one on end-of-life care in the November 15, 2000, issue.
Sources: American College of Physicians—American Society of Internal
Medicine End-of-Life Care Consensus Panel, National Hospice and Palliative
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate
in most instances, but they are not a substitute for medical diagnosis. For
specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied
noncommercially by physicians and other health care professionals to share
with patients. To purchase bulk reprints, call 718/946-7424.
TOPIC: PALLIATIVE CARE
Brender E, Burke A, Glass RM. Palliative Sedation. JAMA. 2005;294(14):1850. doi:10.1001/jama.294.14.1850