What is done when medication doesn't stop agitation?

Hello,

I had a grandmother who passed away on hospice in March of this year, and because of that I occasionally go down rabbit holes of researching hospice, death, etc.

What I really want to know is what is done to stop pain in hospice and what are the protocols when it doesn't work? I saw a video by Hospice Nurse Julie of a poor person, may they rest in peace, screaming in agony from terminal agitation. I've never heard anything so disturbing and heart wrenching in my life. It's also highly disturbing to me that it was recorded, even if for educational purposes, but that's besides the point.

Why is it that terminal agitation seemingly can't be controlled? Is it due to the buildup of toxins in the body from organs shutting down? Is it that only certain drugs can be used and not stronger ones?

Nobody should have to see their loved ones suffer. If it's protocol to allow this, we seriously need change in how we treat our dying loved ones. Saying "there's nothing more we can do" just doesn't cut it IMO.

Sorry, yeah, I'm a bit angry but I needed to get it out. I'm so so lucky my grandmother didn't scream or yell from agitation much. My heart goes out to everyone suffering this.