Current practices in managing end-of-life existential suffering.

Existential suffering (ES) in palliative care can arise independently or alongside physical, psychological, and spiritual pain. With patients increasingly citing ES as a reason for requesting hastened death, a review of recent interventions is timely. Promising new modalities include brain stimulation and psychedelics, while palliative sedation and lethal injections for ES remain ethically controversial and lack a clear clinical definition. Optimal management of ES must also account for institutional and cultural factors that shape care at the end of life.

Study at a glance

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.