In practice, the number of such patients is extremely variable. Reports on sedating treatments at the end of life highlight a confusing terminology of descriptors and perceived problems. The issue of sedation in terminally ill patients is controversial, but it is becoming a more accepted practice, particularly in the hospice setting. For instance, rapid dose titration in the treatment of a distressing symptom could be difficult or impossible if quantities of medications are limited. Pain and symptom management should not be sacrificed simply to avoid the possibility that a patient will have the means for a suicide attempt.
Patients often have other means for a suicide attempt at their disposal.
Inadequate pain and symptom management might in such instances worsen a patient's suicide risk. The need to manage suicide risk requires a reasonable approach to the problem of patient and family access to lethal doses of medication. The most effective resolution to such a clinical dilemma is frequent contact and reassessment. Only with frequent contact will an appraisal of the success or failure of symptom management and its effect on suicidal risk be possible. Regular delivery of medications for limited durations, can be a useful approach to this problem.