| Course | NURS 6914 Advanced Palliative Concepts and Interdisciplinary Perspectives |
|---|---|
| Week | Week 8 |
| Paper type | Discussion post with two peer replies |
| Length | About 690 words, 4 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6914 Week 8
Week 8 Discussion: Initial Post
"Let Me Sleep Until It Is Over": Is Sedation Ever Proportionate for Existential Suffering Alone?
A 59-year-old former high school coach is in the last days of metastatic kidney cancer. His pain and breathlessness are well controlled. What he cannot escape is terror: he wakes several times a night convinced he is dying at that moment, says he cannot bear the waiting and begs the team to "let me sleep until it's over." He has seen the chaplain and a psychologist and has tried the anxiety medicines offered, which dull the fear for an hour or two. Should the team offer sedation for suffering that is existential rather than physical?
Two situations must be kept apart. Sedation for refractory physical symptoms near death, such as agitated delirium or breathlessness that nothing else relieves, is broadly accepted, and the European Association for Palliative Care framework treats it as an established part of palliative practice when used proportionately (Cherny & Radbruch, 2009). Sedation for existential suffering alone is contested. The same framework counsels particular caution, noting that existential distress is harder to judge as refractory, may change with time and support and is less clearly linked to imminent death.
The doctrine of double effect is often used to justify sedation near death. In the account given by Sulmasy and Pellegrino (1999), an act with both a good and a bad effect may be permissible if the act itself is not wrong, the clinician intends only the good effect, the bad effect is not the means to the good and there is a proportionate reason for accepting the bad effect. Applied here, the intended good is relief of terror, and the sedative is not meant to shorten life. Proportionality is where the argument turns: is sedation the least burdensome means that will work?
My position is cautious: for this man, respite sedation, meaning sedation for a set period such as overnight, is proportionate; continuous sedation until death is not yet justified. He is in his last days, his distress is severe and persistent and ordinary measures have been tried. Respite sedation, titrated to relief rather than to unconsciousness and reviewed each morning, would let him rest and would show whether the terror eases or returns. If it returns every time he wakes, and he remains in his final days, a conversation about continuous sedation with him, his family and the full team would then be appropriate. Twycross (2019) warns that the threshold for sedation should not drift downward as it becomes familiar, and a stepped approach guards against that.
Question for the thread: does your setting distinguish respite from continuous sedation in its policy?
Reply to Hannah
Hannah, you argued that existential suffering should never be treated with sedation, because it belongs to the chaplain and psychologist, not the pharmacy. I share part of that concern. Sedation should not replace presence or spiritual care. But in this man's last days, with both already offered, I am not sure the distinction between physical and existential suffering holds up for him. His terror wakes him and he feels it in his body. Twycross (2019) also argues that the categories blur in practice. I would still start with respite rather than continuous sedation precisely because of your concern: it keeps the door open for the chaplain's work when he is rested. Would respite sedation meet your objection?
Reply to Luis
Luis, you asked why the post did not consider medical aid in dying, since he is asking for an end to suffering. I left it out because he has not asked to die sooner; he has asked not to be awake while dying. That is an important difference. Medical aid in dying involves a patient taking medication intended to end life, is legal only in some states and has its own eligibility rules. Palliative sedation aims at relief of symptoms, and under the doctrine of double effect the clinician does not intend death. If he were in a state where aid in dying is legal and he asked for it, that would be a separate conversation with its own safeguards. Mixing the two risks confusing families about what sedation is.
References
Cherny, N. I., Radbruch, L., & Board of the European Association for Palliative Care. (2009). European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliative Medicine, 23(7), 581-593. https://doi.org/10.1177/0269216309107024
Sulmasy, D. P., & Pellegrino, E. D. (1999). The rule of double effect: Clearing up the double talk. Archives of Internal Medicine, 159(6), 545-550. https://doi.org/10.1001/archinte.159.6.545
Twycross, R. (2019). Reflections on palliative sedation. Palliative Care: Research and Treatment, 12, 1-16. https://doi.org/10.1177/1178224218823511
NURS 6914 Week 8 instructions, in plain terms
The Week 8 discussion in this course typically asks you to debate a contested practice in palliative care, such as palliative sedation, and to take a defensible position. Expect a focused initial post citing two or three sources, with two replies later in the week. Separate the accepted form of the practice from the contested one before you argue. Apply an ethical doctrine step by step to the case, and identify the step where the argument turns. Consider graded options rather than a single yes or no. Show what has already been tried, since proportionality depends on it. In replies, concede what is right in a classmate's objection and explain how your position answers it.
How this NURS 6914 Week 8 example is built
The first paragraph presents the case and the question. The second separates the two kinds of sedation and cites Cherny and Radbruch's EAPC framework. The third explains the four conditions of double effect from Sulmasy and Pellegrino and identifies proportionality as the turning point. The highlighted fourth gives the position for respite sedation reviewed each morning and cites Twycross on the risk of a lowering threshold. The post then asks whether classmates' settings separate respite from continuous sedation. The reply to Hannah accepts that sedation must not replace presence and shows how respite sedation keeps the chaplain's work possible. The reply to Luis explains why medical aid in dying is a separate question.
Where the marks sit in the NURS 6914 Week 8 rubric
Debate posts on sedation are usually graded on accuracy about the practice, application of ethical reasoning, a nuanced position and engagement. Accuracy requires distinguishing sedation for physical symptoms from sedation for existential distress, and sedation from assisted death. Ethical reasoning earns credit when a doctrine is applied to the case step by step. A graded position with review points reads as more careful than a flat answer. Engagement is scored on whether replies take a classmate's objection seriously. Current guidance, such as the EAPC framework, should be cited accurately in APA. Tone should respect views that differ, since the topic divides clinicians. A position with a stated review point, such as each morning, is easier to defend than one without.
Common NURS 6914 Week 8 mistakes, and how to avoid them
Sedation posts lose marks when they treat all palliative sedation as one practice. Another common loss is invoking double effect without applying its conditions to the case. Some posts blur sedation with medical aid in dying, which confuses families and graders alike. Others ignore what has already been tried, so proportionality cannot be judged. Separate the accepted and contested forms, apply the doctrine condition by condition, consider respite before continuous sedation, show what ordinary measures failed and keep aid in dying distinct. The desk can draft a post on the practice your prompt assigns. Describe sedation as titrated to relief, never to a level of unconsciousness chosen in advance.
Get a NURS 6914 Week 8 example written to your instructions
Paste in your Week 8 debate question and rubric, plus any classmate positions awaiting a reply. A drafted initial post works through the distinctions with a named ethical doctrine, takes a conditional stance, and carries two replies from other disciplines, returned in 24-48 hours at no charge for a first sample.
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NURS 6914 Week 8 questions, answered
What is the doctrine of double effect?
A principle holding that an action with a good and a bad effect can be permissible if the action itself is not wrong, the bad effect is foreseen but not intended, the bad effect is not the means to the good one, and there is proportionate reason. Each condition is applied in the example to sedation for his distress rather than naming the doctrine and moving on.
Is sedation for existential suffering accepted practice?
It is contested. Sedation for refractory physical symptoms near death is widely accepted in professional guidance, while sedation for existential suffering alone divides clinicians and ethicists. The example states this plainly and argues a cautious position. Your post is likely to score better describing that split faithfully than claiming a consensus that does not exist in either direction.
Why mention medical aid in dying at all?
Only to mark a boundary. Classmates often blur palliative sedation with practices intended to end life, so the post names medical aid in dying as a separate act, lawful under statute in some states and not others, and contested, then sets it aside. The example stays neutral on it, which keeps the discussion on the question actually asked.
Where can I find a free NURS 6914 Week 8 sample paper?
The initial post on sedation for existential suffering, both replies and three references appear here complete, and nothing is charged. A post on the practice your prompt names can be requested.
What does the NURS 6914 Week 8 post recommend?
Respite sedation for a set period, such as overnight, titrated to relief and reviewed each morning, with a conversation about continuous sedation only if the terror returns every time he wakes.