Is the practice of terminal or palliative sedation ethical?

Ethical Issues Palliative sedation represents a part of the spectrum of good clinical practice when used in the appropriate circumstances. The US Supreme Court has supported the right of informed patients to pursue relief of suffering, even if the treatment may unintentionally shorten life.

Why is palliative sedation controversial?

Unlike intermittent and light sedation, CDS is ethically controversial because it ends a person’s ‘biographical life’ (the ability to interact meaningfully with other people) and, if prolonged, shortens ‘biological life’. Family concerns,17 sedation in children18,19 and in Intensive Care Units20 will not be discussed.

Is palliative sedation ethically different from active euthanasia?

The dominant view is that euthanasia and palliative sedation are morally distinct practices. When heterogeneous sedative practices are all labeled as palliative sedation, there is the risk that palliative sedation is expanded to include practices that are actually intended to bring about the patients’ death.

What is the difference between terminal sedation and euthanasia?

In the case of terminal sedation, severe physical and psychological suffering prompt the physician to sedate the patient, whereas for patients requesting euthanasia, perceived loss of dignity during the last phase of life is often a major problem.

When is palliative sedation appropriate?

‘Existential Suffering’ There is widespread agreement that palliative sedation is appropriate for intractable physical pain, extreme nausea and vomiting when other treatments have failed.

What is a complex ethical dilemma?

Ethical dilemmas are situations in which there is a difficult choice to be made between two or more options, neither of which resolves the situation in a manner that is consistent with accepted ethical guidelines.

Is terminal sedation a form of euthanasia?

As far as terminal sedation is causally contributory to the patient’s death as a side effect, the case is one of indirect euthanasia. As far as the termination of treatment is causally contributory to the patient’s death intended as a means, the case is one of passive euthanasia.

Is palliative sedation legal?

For example, it would be lawful to use palliative sedation to manage refractory symptoms, with the intention of relieving pain and suffering, not hastening or causing death, and so long as the person continues to receive nutrition and hydration.

What is the difference between palliative sedation and terminal sedation?

Definition. Palliative sedation is the use of sedative medications to relieve refractory symptoms when all other interventions have failed. The phrase ‘terminal sedation’ was initially used to describe the practice of sedation at end of life, but was changed due to ambiguity in what the word ‘terminal’ referred to.

Is terminal sedation active euthanasia?

What are the ethical issues with palliative sedation?

The intent of the patient, like that of the clinician, must also be considered. Ethical and moral dilemmas may arise when a patient furtively desires a quick death by requesting palliative sedation; if the patient’s intent is known or suspected, ethical and psychiatric consultations are obligatory ( Rousseau 2000 ).

When to use terminal sedation in terminal illness?

Terminal sedation is used in patients with terminal illnesses where normal medical treatments cannot relieve severe symptoms such as pain and agitation, and no option is left but to take away the perception of these symptoms.

Can a patient be sedated without informed consent?

Informed consent. There is a distinct possibility that sedation can also be initiated without explicit consent of the patient or surrogate: Palliative sedation should not be instituted without the explicit informed consent of the terminally ill patient (who is suffering from refractory symptoms) or surrogate.

Why are people sedated in end of life care?

The goal is to control symptoms, and the patient is sedated to varying degrees of consciousness to achieve this. The intent is not to cause or hasten death, but rather to relieve suffering that has not responded to any other means. Often the patient is sedated to a point at which they are unconscious.