On Sedating
My personal views
Corne van Nijhuis
I have been affiliated with a hospice for several years. From there I am deployed as a buddy for mostly single elderly people who still live independently, but know that their end of life will be approaching in the short term (weeks/months). In that situation, the conversation naturally turns to the mystery of life and especially dying, with all the unknowns and uncertainties that come with it. The conversation recently focused on the question of how I viewed palliative sedation. In this contribution I would like to share my impression of this, because I know that it is a widely felt issue, but many do not really look into it in advance. So this is my personal view below. The idea that it is relevant here lies in the relationship with the underlying image of humanity.
Image of humanity
When we think about life and death, we must first have a clear idea of what ‘man’ is. And as our language shows, we are neither our body nor our mind. It is not without reason that we say: ‘my body’ and ‘my mind’. But who or what is that ‘me’ or the ‘I’?
For me, the true essence of man is his sense of being a witness (the subject), or in other words, his inner consciousness (and I don’t mean the mind). An inner consciousness in which, for example, thoughts appear. A consciousness (subject) that manifests itself in an appearance (object) that, in addition to the physical or biological expression (body), also includes a metaphysical or psychological expression (the mind, NOT being the subject).
But if man is only ‘inner consciousness’, why do I feel like ‘a person’? This is because in the brain the mind (the mind) has constructed a self-image, which in itself is only a thinking construct, a thought. But that construct is then seen by the mind as an autonomous entity or, in other words, a personified individuality – an ego that we think we are. So once again formulated: With our thinking capacity we have created an ego (thought construct) with which we identify ourselves. We do this while in reality we are only the subject or the ‘witnessing or perceiving inner universal consciousness’ which itself knows neither individuality nor personification – it is only the (universal) witness.
The special thing about consciousness is that it cannot experience itself, just as the fire cannot illuminate itself and we cannot look ourselves in the eye. At the same time, the fact that man feels like a witness is the only absolutely certain thing he experiences and what is always there.
Another relevant feature of consciousness has once again been confirmed to us by the latest insights from quantum physics. Everything in the universe is both a particle and a wave, simultaneously. The characteristic and behavior only takes shape as soon as measurement takes place, or in other words as soon as it is exposed to consciousness (and it therefore does not have the properties for that). These results support the old insights that consciousness is more fundamental than matter. From the premise that consciousness is fundamental, in my view of existence everything that presents itself in consciousness is a manifestation of consciousness in consciousness.
So consciousness is not aware of itself, but it is undeniably the reality in which everything presents itself. We can explain this phenomenon of presentation as sensations of experiences. So there is an essential difference between consciousness and sensation (and being aware). Consciousness is the fundamental reality in which sensory-experienced projections appear. Signals from the senses create manifestations in consciousness or rather: in consciousness and of consciousness. We can refer to such manifestations as sensations. You could visualize it as a certain vibration in and of consciousness.
As has been made clear above, in my view of humanity, on the one hand the universal consciousness or the subject is essential and on the other hand the object consisting of the body, the mind/mind and sensations generated by the body and mind.
Die
From the described view of humanity, we could see dying as the disconnection of consciousness (the subject) from the body and the mind (the object). Due to this disconnection, the thinking construct (ego) and thus individuality disappears, because the thinking mind is extinguished due to the failure of the brain (mind/thinking capacity). During the dying process, the capacity for sensation decreases, because the sensory signals can no longer be projected by the brain into consciousness. So although consciousness is unchanged, the sensory input slowly fades away. What ultimately remains is primarily a consciousness free of ‘input’, free of the thinking construct/ego (personality) and without individuality: universal consciousness. Secondary remains the karmic impression of the life lived (something I will not go into further in this context).
Palliative sedation
When I look at the influence of palliative sedation in the dying process from the previous view of humanity and my vision on dying, I come to a conclusion that may be surprising to some. Before looking at the influence, however, it is good to first clearly determine what exactly palliative sedation is and what exactly it aims to achieve.
Palliation means to relieve or soften and sedation means to calm down. The purpose of palliative sedation is to prevent unbearable physical suffering (pain) and to provide mental peace (such as preventing extreme anxiety) in the terminal phase. The important thing is that you can live through this phase as comfortably as possible. A phase in which food and drink are no longer administered, with the idea that one will soon and eventually die in a relatively natural manner from the underlying suffering. Palliative sedation is therefore aimed at making someone as comfortable as possible, without aiming to accelerate the dying process. There is therefore no question of an unnatural death such as with euthanasia. The underlying goal of all good care surrounding an approaching inevitable end of life, including something like palliative sedation, is to allow people to experience their dying in dignity, whereby someone remains as able as possible to maintain meaningful relationships with others, on the one hand, and the spiritual’ and to itself.
But what exactly happens to ‘the person’ during palliative sedation? By administering certain medication (midazolam), it is ensured that sensory signals, including thinking, no longer lead to sensations that arise in consciousness. This means that in this unique phase of life one turns away from the sensations. While it is precisely at this stage that the sensation of the disconnection of consciousness and the body-mind combination, or the transition from the physical world to the spiritual world, is possible. It is in this phase that the attention to the relationship with ‘the spiritual’ as well as (and perhaps especially) to themselves comes to the fore for many like no other time in life. A phenomenon whose significance, in my view, should not be underestimated. It is the sensations in this phase of the dying process that make dying valuable as part of human existence. However, the risk of palliative sedation is that ‘anaesthesia’ leaves insufficient room for social, but above all emotional and spiritual aspects that encompass something as complex as dying. This includes things such as saying goodbye to others, but even more importantly processing personal feelings and, above all, realizing spiritual development.
So in my view it is essential to remain sufficiently informed during this phase. Putting you to complete sleep, where sensory sensations are no longer possible, is obviously at odds with this. A balanced level of medication administration is therefore crucial. Enough to experience reasonable physical and psychological comfort, but not too much to lose sense of life. Sedation dampens sensory sensations without putting one to sleep. A position in which the mind can still function sufficiently, without experiencing physical and psychological pain that is difficult to bear. All this aimed at experiencing dying as ‘consciously as possible’.
Overall, I feel I have presented a very personal perspective. That is why I would like to conclude differently than usual with a personal comment: based on my vision on palliative sedation, I feel able to have the ambition to walk the path of life ‘consciously’ to the end and to live until I die. As my human end approaches, I hope I can muster the strength to walk that path.
Good vibes!
Corne
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Dhr Corne van Nijhuis is a Vedanta scholar. He contributes regularly to this magazine. He has written and translated books, and has travelled extensively almost all over the globe. His in depth study into Vedanta and other systems helps him express difficult ideas in a simple and easily comprehensible way.