Perhaps these are the questions we must answer if we truly wish to accompany someone who is suffering. But let us remember that the one who suffers is the only one who knows what suffering is and what alleviates their suffering. Suffering is a fundamental dimension of the human condition and a frequent companion in the final stages. Therefore, those of us dedicated to palliative care have the mission of accompanying those who are suffering, providing them with relief through appropriate management of the symptoms that cause them suffering, through adjusting therapeutic efforts to avoid treatments that are no longer effective and would cause them more suffering than the illness itself, and, if suffering persists, through palliative sedation, reducing their consciousness to prevent them from being aware of their suffering.

Bodies don’t suffer; only people do. Therefore, I believe that suffering has physical, emotional, social, and spiritual dimensions, and we must address it with holistic care to alleviate the person’s “total suffering.” When we accompany and care for patients with advanced, incurable, or terminal illnesses, we find that the causes of their suffering correspond to these four dimensions. They may suffer from the unwanted side effects of treatments, from poorly controlled symptoms, from the loss of their social role, from feelings of dependence and being a burden on others, from inadequate psychosocial situations such as lack of privacy, lack of companionship, unwanted loneliness, estrangement from family, from changes in their physical appearance due to a tumor, from not feeling loved, from unresolved issues, from negative thoughts of guilt, from fear of the future, and so on.

Most of the suffering that occurs in the final stage of life is not solely related to physical pain, but can also stem from emotional, social, or spiritual issues, as well as an inability to resolve life’s deepest questions. Those who are dying are very likely facing profound problems due to the proximity of death, such as having to leave loved ones and having unresolved certain outstanding matters.

What does a sick person who is suffering need?

We must not prolong their suffering by insisting on using diagnostic or therapeutic techniques that are of little or no use in remedying their illness in their current clinical condition and that often increase their suffering. When necessary, because in the few days or hours preceding their death they are experiencing intolerable suffering that does not respond to palliative interventions, including the most aggressive ones, we must resort to palliative sedation. The appropriateness of therapeutic effort and palliative sedation are two ethical imperatives in palliative care to alleviate the suffering of those who endure it.

When suffering becomes unbearable and cannot be alleviated in any way, we consider it refractory suffering, which requires a solution by relieving the patient of further suffering. For this purpose, palliative medicine offers a suitable therapeutic tool to relieve the person of this level of suffering as they approach death: palliative sedation. If palliative sedation is properly indicated, authorized by the patient, and administered correctly, it is good medical practice. Palliative sedation does not aim to delay death, nor to hasten it; its sole purpose is to alleviate the patient’s suffering until death arrives.

It is important to clarify that the boundary between  palliative sedation  in the dying process and active euthanasia lies in their primary aims. Sedation seeks to achieve, with the minimum necessary dose of medication, a level of consciousness in which the patient does not suffer physically, emotionally, or spiritually, although it may indirectly shorten their life.  Euthanasia, on the other  hand, deliberately seeks premature death through the administration of lethal doses of medication to end the patient’s suffering. As can be seen, palliative sedation has nothing to do with euthanasia. The difference in intent, process, and outcome is clear.

We must remember that the appropriate treatment of suffering is a priority in the care of all patients and is rooted in the very origins of the medical profession. When faced with someone suffering, healthcare professionals cannot turn a blind eye; we must offer our help to alleviate their suffering. Universal and accessible palliative care for all citizens who need it is a necessity that must be transformed, as soon as possible, into a right.