however I don't think they put people on ventilators without pain meds and sedation, ever , even if they're in respiratory distress.
I would hope not. I can imagine that being very uncomfortable.
Conveniently, being on a ventilator removes the one major risk of opioid use at high doses, as well. I would argue they have an obligation to pump me full of narcotics if they're going to abuse my windpipe. I am not suited to audition for
Deep Throat after all...
A lot of people fail to realize that palliative care is more than just relieving "pain", there are all sorts of niche symptoms of discomfort that can be very bothersome.
Palliative care is arguably one of the few medical practices where I see shades of "heroic medicine" still persisting. For instance, "Brompton's cocktail" was once given to the dying. It was effectively a mixture of every euphoriant drug the physician could manage to supply. The classical recipe calls for morphine or heroin, cocaine, chlorpromazine, strong ethyl alcohol, and chloroform as active ingredients (with some simple sugar syrup and flavoring added, for all the good that would do), but often substitutions or additions were made. Wiki:
Some specifications for variants of Brompton cocktail call for methadone, hydromorphone, diamorphine (heroin), or other strong opioids in the place of morphine; diphenhydramine or tincture of cannabis in place of the chlorpromazine; and methamphetamine, amphetamine, dextroamphetamine, co-phenylcaine (lidocaine and phenylephrine hydrochloride), methylphenidate, or other stimulants in the place of cocaine.
Now, in any other context, someone trying to fill such a prescription would be laughed out of the pharmacy. Most people wouldn't even believe such a thing could ever have a use outside of a really wild party (
those sorts of parties, you know, the kind
you don't get invited to), but yet it works to give those in their final days as a mortal a more comfortable time.
It seems like a more benevolent cocktail of pharmaceuticals than some of the medications used today. I would rather be speedballed to death than have my soul smothered slowly by benzodiazepines and antipsychotics, living my last days in a fog of amnesia with no recollection of the present.