My father is terminally ill and receiving hospice care in his home. Every time the hospice nurse visited last week, he asked in a half-joking way, "Did you bring the black pill for me today?" The nurse replied, "No, but when the time comes, I promise you won't be in pain."
I know she meant to reassure him, but I feel she trivialized his concerns. What do you think?-I.T., R.I.
I agree. This nurse is missing an opportunity to simply ask your dad why he needs a "black pill" and what he thinks it would do for him. For example, is he seeking assisted suicide?
If he answers with something like, "It'll just end everything," the nurse needs to continue asking why he needs everything to end right now.
When patients give this kind of response, they're typically worried about managing pain and other symptoms. Even though hospice addresses these problems aggressively, determine if more can be done for your dad. If he's suffering with intractable nausea, for example, he may need a second or third antiemetic. If he's in pain despite treatment with an opioid, ask to increase the dose, not the frequency.
But if your dad says he wants a "black pill" because he's suffering in his soul, a place no drug can reach, his caregivers need to assess that symptom just as attentively as they assess physical signs and symptoms.
If his suffering is existential and intractable, it's morally and professionally justifiable to provide terminal sedation at the end of life-that is, to give frequent doses of lorazepam (Ativan) and morphine so he's no longer in physical or psychic pain. He'd no longer eat or drink but would have the stress of dying relieved by being unaware of his condition.
The next time the hospice nurse visits, discuss your concerns with her. Together, you can talk with your dad and explore his wishes for end-of-life care. Hospice programs are committed to providing dignity and peace for their clients. This is the time for your dad's hospice caregivers to honor that promise.