How do we know the palliative patient isn't suffering at end of life?

[Edict]

Is there any evidence that shows palliative patients aren't suffering in their final moments? For example, if they moan, gurgle or have irregular breathing, how do we know our medications are really adequate? 

[Bluberblubo]

I've thought about that a lot too. I'm not sure if there is evidence for it, but from my experience, I can say that if the patient looks like they're in pain from their facial expressions and they get morphine their expression changes. I have also thought about, what if all these things we do that are commonly found on a palliative care order set are just things we do to make ourselves and the patient's family feel better. Who knows right? 

How would one study something like this too? When patients are in their last moments of life when you would use stuff like scopolamine etc they tend to be nonverbal anyways...

[NeuroD]

From a neurological/consciousness POV, we don't. It's technically and ethically a very difficult question to get the data you would need for evidence-based decision making.

Given that we haven't yet figured out how/where memory/sensation is stored/experienced in the brain, it's really hard to know what they're going through.

[Edict]

Yeah, this is what I figured, this online module i'm taking is telling us to tell patients families that the moaning, gurgling and irregular breathing are normal and they aren't suffering... but should we really be saying these things if we don't know they are true. 

 

[Butterfly_]

I had a similar question and I asked a mentor. He recommended me to read an article published in the New England Journal of Medicine back in 1983 called “The nature of suffering and the goals of medicine” written by Dr. Eric Cassel. It doesn’t address your question exactly, but it provides good insight on this topic.