I always enjoy reading Joy Ufema's column, Insights on Death and Dying. Her advice in "Terminal Sedation: Taking a 'Black Pill'" (September 2007)* caused me to reflect on our obligation as nurses to provide spiritual care to terminally ill clients.

As a faith community nurse, I found this advice to be particularly profound: "If [horizontal ellipsis][the client] 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." I agree wholeheartedly with this directive.

However, I disagree with the author's contention that "if[horizontal ellipsis]suffering is existential and intractable, it's morally and professionally justifiable to provide terminal sedation." If such existential suffering resides in the soul-"a place no drug can reach"-why should caregivers immediately attempt to reach it with anesthetizing drugs? Suffering in the soul (spiritual distress) is a nonphysical phenomenon that calls for nonphysical intervention: spiritual care.

When the nurse identifies serious spiritual distress, she should facilitate the involvement of spiritual care professionals, such as pastoral counselors and clergy. Ideally, pastoral care should be provided to all patients when they first enroll in hospice, and it should include a documented spiritual care plan, which lists the client's own directives and preferences.

"Snowing" a client in spiritual distress to facilitate a hasty departure or to dull the emotions may not be as merciful as it seems. Many people who experience spiritual distress in dying have unfinished business, which they can't adequately address or accomplish if they have insufficient clarity of mind or are escaping the issue with drugs. Furthermore, families need to get closure and say good-bye.

Ideally, the experience of death should be a loving, meaningful, and peaceful transition to the next state of existence for the client and his family. This doesn't mean that dying can be expected to be easy or completely pain-free.

TERRILYNN FOX QUILLEN, RN, MSN

Greenwood, Ind.

^*Individual subscribers can access this article free online at http://www.nursing2007.com. [Context Link]