The Reality of Medically-Induced Comas: Should We Keep it Our "Dirty Little Secret"?

The Hidden Risks of Sedation and Immobility: A Call for Patient Autonomy

I know this might ruffle some feathers, but what's necessary must be said. If you're uncomfortable with this, I challenge you to reflect and ask yourself, "Why?"

Patient Autonomy: A Core Nursing Value

Patient autonomy has always been a cornerstone of nursing, guiding me throughout my journey as an ICU revolutionist. In 2007, I learned that one of my critical roles as a nurse was to educate and protect patient autonomy.

A Realization After Years in the ICU

After spending 3 years sedating patients across 11 ICUs, I realized I had unknowingly increased their risk of harm and mortality. Neither they nor their families were informed of these risks.

The Risks of Sedation and Immobility

While uncovering shocking research during the recording of my podcast, "Walking Home From the ICU," I pondered a crucial question:

"Don't patients and families have a right to know the risks of sedation and immobility?"

Despite minor surgical risks being disclosed to patients, the severe risks associated with continuous sedation—like increasing delirium risk by 214% and 7-day mortality by 68%—usually go undisclosed.

Spencer Freeman and the Price of Ignorance

Episode 58 features Spencer Freeman's story of struggling with PTSD and cognitive impairments from sedation and delirium. Having lost his career as an attorney due to the PTSD and being misunderstood and fearful of being labeled insane, Spencer had decided to take his own life.

  …until he found my podcast. Learning the word, “Delirium”, saved his life. The realizations that:

-He wasn’t crazy, he was injured.

-He wasn’t the only one. This wasn’t just in his mind.

Led to significant hope and progress throughout the following years. He now fathers an incredible son and lives a full life.

How many more "survivors" are suffering in silence and ignorance?

Uninformed Patients: A Public Concern

The public deserves to know: Would people choose sedation if aware of the risks? During my travels, I asked this question—listen to their insightful responses in episode 195. Almost everyone preferred to stay awake, valuing awareness and autonomy over sedation. They asserted that patients have a right to know sedation risks, with some speculating on the legality of non-disclosure.

Challenges in the Medical Community

I took a poll on social media this week. Despite hundreds of healthcare professionals agreeing on the need for transparency they confessed that disclosure is not standardized. They even shared that clinicians can face reprimands for educating families.

This week, a revolutionist at a large and renowned academic hospital was formally rebuked in writing for talking with families about the risks of sedation, delirium, and immobility. They were informed that the rest of the team had not decided to share that information with the family and therefore they had no right to provide any education that would make the families aware.

Another revolutionist shared the following :

Another revolutionist shared:

In the Line of Fire

Part of the social media campaign against me to have my license revoked was that I making information about sedation and immobility accessible to the public and families in the ICU through my podcast, “Walking You Through the ICU”.

All of the information shared is evidence-based with the goal of helping families understand their role in the ICU, how to collaboratively help the ICU team provide the best care for their loved ones, and how to prepare for life after the ICU.

Yet, to thousands of nurses, the idea of having families know that prolonged sedation potentially increases the risk of mortality, life-long cognitive impairments, PTSD, and life-long physical impairments was enraging.

Ethical and Legal Considerations

In 2025, how is this ethically and legally acceptable to keep patients and families in the dark?

Let’s talk about the ethical principles that obligate us to provide informed consent to patients and families about their care.

Ethical Aspects of Informed Consent:

1. Autonomy and Self-Determination:

Informed consent is grounded in the ethical principle of respecting patient autonomy and allowing them to make their own choices about their healthcare. 

2. Beneficence and Non-maleficence:

This includes several moral rules and I want to point out a few that we should especially consider here in the context of considering and disclosing the high risks of sedation which are:

A. Do not kill

B. Do not cause pain or suffering

C. Do not incapacitate.

Ultimately, if we are drastically increasing risk of mortality, causing or contributing to suffering, and incapacitating our patients in the short and potentially long-run--- Are we really practicing non-maleficence with automatic sedation and immobility?

Especially when we don’t even disclose the risks?

Legal Aspects of Informed Consent:

1.Statutory Law:

Some states have requirements for informed consent or providers may be liable for negligence.

2. Duty to Disclose:

Healthcare providers have a legal duty to disclose material information to patients, even if they don't believe it will impact the patient's decision.

Could survivors or families hold us accountable for failing to disclose this information? If they have these life-threatening and life-altering complications from being sedated and immobilized but the risks were never disclosed beforehand, can it be claimed that the legal obligation of duty to disclose was not honored?

3. Reasonable Disclosure:


The level of disclosure required is generally determined by what a reasonable person would want to know to make an informed decision about their care.

At least to those that I interviewed, the general public seemed to think it was reasonable to disclose these risks prior to or right after intubating a patient.

Your Thoughts?

What are your thoughts on this issue? Do patients and families have a right to know the risks?

Should educating them subject clinicians to risk of reprimand?

Share your thoughts in the comments!