Terminal pain relief

People who are principally opposed to euthanasia are often also suspicious of terminal pain relief. In itself that is understandable: all too often pain relief is used to give a patient increasing doses of morphine, in order to eventually ‘release him from his pain’. Obviously, communication between the patient and/or his family is particularly important here.

It demands the utmost care to make clear what terminal pain relief entails and how it is carried out, so as to prevent misunderstandings and suspicions from arising about this last stage of life. To what extent should a potentially life-shortening effect be accepted, and what is the consequence of consciously not administering drugs and/or techniques that relieve pain?

After all, it may never be the case that someone presumes to pass judgement as to the time and manner in which the life of a patient should be ended. Man would then assume the position of Divine Judge in order to pass judgement on (the meaning) of life. However, it would be sad, even cruel, if the fear of misuse were to result in the insufficient correct use of pain relief in the terminal stage.

Clear difference between terminal pain relief and euthanasia
So it is necessary to distinguish between (real) terminal pain relief and euthanasia. It is important to be clear in this respect, and to involve the patient and/or those close to him in the underlying considerations of administering the various drugs or techniques.

Structuring

If situations require clarity and structure, an effective means is regulation by means of protocols, requirements, codes of conduct etc. In the Netherlands, many institutes have now arranged this in the context of euthanasia, this would also be feasible for terminal pain relief. It would now be too limited to provide structure for the last stage of life only in the field of pain relief. However, within the framework of this topic, only the latter aspect is discussed here.

For healthcare providers who administer morphine, it is necessary to know how to deal with this matter in a conscientious way. For the patient and his close relatives, it would also be reassuring to know that a properly considered policy is being carried out which is focused on preventing an overdose. And yet terminal pain relief is not necessarily restricted to medication. Nowadays, anaesthetists can selectively perform nerve blocks, and medicines are administered through an epidural/spinal catheter (around the spinal cord).

Sometimes a small surgical intervention can provide relief, for instance with an impending intestinal obstruction, or a stent can be implanted to prevent impending suffocation with a gradual closure of the airway. These palliative interventions are not healing, but can provide enormous relief. However, these techniques will not be elaborated upon, because they do not create dilemmas that cause conscientious objections.