Palliative Terminal Sedation: Is it Ethical?
Palliative care is treatment rendered to relieve the pain and suffering of an illness through the means of medications and other techniques both in situations where active treatment for the underlying illness is being carried out or in situations where there is no medical treatment to provide a cure and simply patient comfort care is the intent of the healthcare providers.
Palliative terminal sedation is a technique of providing palliative care to terminally ill patients who despite attempts at other methods of palliative treatment fail to get relief from pain and suffering. The technique involves administering drugs that maintain unconsciousness when treatments to reduce pain and suffering in the conscious patient has failed, as they occasionally do. The intent of those who provide palliative terminal sedation is the relief of the suffering by rendering the patient unconscious and not to cause the death of the patient which death when it occurs is generally attributed to the patient’s underlying fatal illness. With palliative terminal sedation, however, it might be found that the arrival of death may be accelerated but this is not the intent of the providers.
The question that has ethical implications is whether palliative terminal sedation is actually a form of euthanasia or physician-assisted suicide (PAS). Euthanasia is illegal in the United States. PAS is not accepted as professionally ethical by many and, of course, in the United States PAS is illegal except for its restricted and controlled application in the state of Oregon. The difference between euthanasia, PAS and palliative terminal sedation is clearly one of intent of the provider. In euthanasia, directly producing death at the request of the patient is the intent of the physician. With PAS, the intent is to provide the patient a means to end their own life (suicide). With palliative terminal sedation, the intent is to produce unconsciousness which finally relieves the patient of pain and suffering. Causing death or accelerating death is not the intent.
An interesting article supporting this view can be found in the January 2008 issue of the Journal of Palliative Medicine (Volume 11 Number 1 p76-81 by MARK F. CARR, Ph.D. and GINA JERVEY MOHR, M.D. in an article titled “Palliative Sedation as Part of a Continuum of Palliative Care”. (Note: the link is to the full article which was free at the time of this posting but may not be available free in the future.)
Do all my visitors accept the notion that palliative terminal sedation is an ethical practice for the physician’s treatment of a terminally ill patient? ..Maurice.