The Importance of Consciousness in Palliative Care

One of the core competencies of palliative care is to assist the patient, the suffering person, the ‘homo patiens’. In doing so, alleviating suffering is not an end in itself, but rather the aim is to support the person in such a way that he or she can continue and complete his or her life’s work as well as possible, despite any suffering. As the Australian palliative physician Norelle Lickiss put it: ”Create time, space and relief from suffering in order to allow patients to complete their symphony.”

Since time immemorial, medications have been used to put people with therapy-resistant symptoms temporarily (or permanently) into a kind of sleep as a last resort (called therapeutic sedation) to enable them to endure the situation. Thus, in extreme situations people accept that the patient’s consciousness can be reduced in favor of better symptom control.

In recent years, we can observe a strong increase in medically prescribed sedation. What are the reasons for this?

• In the debate about the expanding practice of active euthanasia or medically assisted suicide in some countries, palliative care has been presented by various people as an alternative, and the possibility of sedation has been praised. This is problematic because, with correctly administered therapeutic sedation, the end of life is never the goal and, according to studies, it does not lead to a shortening of life (1).
  
  
• In public discussion, as well as in everyday life at the sickbed, we may hear people say that it is not “humane” that animals can be euthanized, but human beings are not allowed to fall asleep forever with the help of an injection.
  
  
• And last but not least, it is a fact that “sedated” people appear more “peaceful” from the outside perspective of practitioners. Sedation makes dealing with the situation “easier”, at least superficially – not only for the nurses, but also for doctors and other staff, and of course for the relatives. It should be remembered that the inner perspective of the patient can be quite different.

There is therefore a clear tendency and, in certain situations, pressure, to sedate patients more often. In this section we would like to show why consciousness is so important for human beings, including in the last phase of life, (2) and offer suggestions for how this can be worked with in everyday life.