Current practices in managing end-of-life existential suffering.
Michelle Di Risio, Alison Thompson
Current opinion in supportive and palliative care June 1, 2023 DOI: 10.1097/SPC.0000000000000646
Summary
Existential suffering (ES) significantly impacts end-of-life experiences, with many patients citing it as a reason for requesting hastened death. A review of interventions targeting ES highlights promising approaches like brain stimulation and psychedelics. However, the use of palliative sedation and lethal injections for ES relief raises ethical concerns due to the intertwined nature of suffering types. The evaluation of ES management tools should also account for institutional and cultural factors that influence care for dying individuals, ensuring a comprehensive approach to palliative care.
Abstract
Within the context of palliative care, existential suffering (ES) can be an exclusive source of suffering or intertwined with physical pain and/or psychological and spiritual suffering. With newly emerging modalities for addressing this phenomenon and its increasing salience given that many patients cite ES as a significant contributing factor to requests for hastened death, a review of recent interventions for addressing ES at the end of life is timely. This review of newer approaches to dealing with ES in the palliative context suggests some promising new modalities and pharmacological interventions, such as brain stimulation and the use of psychedelics. The use of other pharmacological interventions, such as palliative sedation and lethal injections, solely for the alleviation of existential distress remains ethically controversial and difficult to disentangle from other forms of suffering, not least because a clear clinical definition of ES has yet to emerge in the literature. The evaluation of end-of-life (EOL) ES mitigating tools should also consider how broader contexts, such as institutional arrangements and barriers, and cultural factors may influence the optimal management of dying persons' ES in the palliative care setting.