Palliative sedation, legal alternative to assisted suicide, is widely used

TOWARD the end, the pain had practically driven Elizabeth Martin mad.

By then, the cancer had spread everywhere, from her colon to her spine, her liver, her adrenal glands and one of her lungs. Eventually, it penetrated her brain. No medication made the pain bearable. A woman who had been generous and good-humoured turned into someone hardly recognisable to her family: paranoid, snarling, violent.

Sometimes she would flee into the California night in her bedclothes, “as if she were trying to outrun the pain,” her older sister Anita Freeman recalled.

Martin fantasised about having Freeman drive her into the mountains and leave her with the morphine drops she had surreptitiously collected over three months – medicine that didn’t relieve her pain but might be enough to kill her if she took it all at once. Freeman couldn’t bring herself to do it, fearing the legal consequences and the possibility that her sister would survive and end up in even worse shape.

California’s aid-in- dying law, authorizing doctors to prescribe lethal drugs to certain terminally ill patients, was still two years from going into effect in 2016. But Martin did have one alternative to the agonizing death she feared: palliative sedation.

Under palliative sedation, a doctor gives a terminally ill patient enough sedatives to induce unconsciousness. The goal is to reduce or eliminate suffering, but in many cases the patient dies without regaining consciousness.

The medical staff at the acute care center in Long Beach where Martin was a patient gave her phenobarbital. Once they

At least she got into that coma state versus four to eight weeks of torture.

Anita Freeman, patient’s sister

calibrated the dosage properly, she never woke up again. She died within a week, not the one or two months her doctors had predicted before the sedation. She was 66.

“At least she got into that coma state versus four to eight weeks of torture,” Freeman said.

While aid-in- dying, or “death with dignity,” is legal in seven states and Washington, medically assisted suicide retains tough opposition. Palliative sedation, though, has been administered since the hospice care movement began in the 1960s and is legal everywhere.

Doctors in Catholic hospitals practice palliative sedation even though the Catholic Church opposes aid-in- dying. According to the US Conference of Catholic Bishops, the church believes that “patients should be kept as free of pain as possible so that they may die comfortably and with dignity.”

Because there are no laws barring palliative sedation, the dilemma facing doctors who use it is moral rather than legal, said Timothy Quill, who teaches psychiatry, bioethics and palliative- care medicine at the University of Rochester Medical Centre in New York.

Some doctors are hesitant about using it “because it brings them right up to the edge of euthanasia,” Quill said. But “if you are going to practise palliative care, you have to practise some sedation because of the overwhelming physical suffering of some patients under your charge.”