THE PROCESS of dying is a milestone that allows patients and family members a time of reconciliation, personal growth, and spiritual enrichment.1 However, to achieve a dignified and serene death, alleviation of suffering is a moral imperative, which is obligatory and cardinal at the end of life.2 Lamentably, many terminally ill patients endure significant suffering that undermines quality of life and precludes a peaceful and tranquil death. This is not entirely unexpected as physical symptoms become more interminable and laborious and existential and spiritual concerns emerge. When physical and psychosocial symptoms become refractory, clinicians may be challenged morally and emotionally and may continue with suboptimal therapy or unintentionally abandon or distance themselves from dying patients. Although relief of symptoms with preserved function is the usual goal of medicine, at the end of life, relief of suffering may predominate over all other considerations, including the maintenance of consciousness.3
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