Death without distress? The taboo of suffering in palliative care

Abstract

Palliative care (PC) names as one of its central aims to prevent and relieve suffering. Following the concept of "total pain", which was first introduced by Cicely Saunders, PC not only focuses on the physical dimension of pain but also addresses the patient's psychological, social, and spiritual suffering. However, the goal to relieve suffering can paradoxically lead to a taboo of suffering and imply adverse consequences. Two scenarios are presented: First, PC providers sometimes might fail their own ambitions. If all other means prove ineffective terminal sedation can still be applied as a last resort, though. However, it may be asked whether sedating a dying patient comes close to eliminating suffering by eliminating the sufferer and hereby resembles physician-assisted suicide (PAS), or euthanasia. As an alternative, PC providers could continue treatment, even if it so far prove unsuccessful. In that case, either futility results or the patient might even suffer from the perpetuated, albeit fruitless interventions. Second, some patients possibly prefer to endure suffering instead of being relieved from it. Hence, they want to forgo the various bio-psycho-socio-spiritual interventions. PC provider's' efforts then lead to paradoxical consequences: Feeling harassed by PC, patients could suffer even more and not less. In both scenarios, suffering is placed under a taboo and is thereby conceptualised as not being tolerable in general. However, to consider suffering essentially unbearable might promote assisted dying not only on an individual but also on a societal level insofar as unbearable suffering is considered a criterion for euthanasia or PAS.

Wahrnehmungen zum Umgang mit Opioiden bei COVID-19

“…Prinzipiell sind Vorbehalte gegenüber dem Einsatz von Opioiden ein weltweit bekanntes Phänomen, das zu einer Unterversorgung von Patienten führen kann [ 7 ]. Dazu kommen Aspekte wie Assoziation von Morphin mit Abhängigkeit, Sterben [ 10 ] und dem Nicht-Aushalten von Leid [ 29 ]. Da in der SARS-CoV-2-Pandemie eine starke psychische Belastung des medizinischen Personals besteht, kann die Konstellation aus Vorbehalten, Unsicherheiten und auch heterogenen Leitlinien verschiedener Fachgesellschaften die medizinische Versorgung und angemessene Symptomkontrolle von Patienten mit COVID-19 zusätzlich erschweren.…”

Suffering

“…from a broad phenomenologically informed perspective. Streeck (2020) maintains that the strong focus on prevention and relief of suffering within palliative care might have unintended but seriously negative consequences. In particular, she sketches two different pathways in which this might play out.…”

“…Accordingly, it can materialize in quite different forms: bodily agonies, a loss of engagement in the world together with others, or the inability to realize core life values. Streeck (2020) accepts the way suffering has been conceptualised in palliative care from its early days, i.e. as a complex phenomenon involving bodily, psychological, social and spiritual or existential dimensions.…”

Percepção De Enfermeiros Quanto Ao Ambiente Estrutural De Uma Unidade De Saúde De Belém

“…A abordagem da dor total consiste em acessar não só a dor física do paciente, mas também aspectos psicológicos, sociais e espirituais (STREECK, 2019).…”