Hastings Center Rep.: Terminal Sedation: Pulling the Sheet Over Our Eyes.

AuthorBattin, Margaret P.
PositionAbstracts

Terminal sedation, also called palliative sedation, continuous deep sedation, or primary deep continuous sedation, has become a new favorite in end-of-life care, a seeming compromise in the debate over physician-assisted dying. Like all compromises, it offers something to each side of a dispute. But it is not a real down-the-middle compromise. It sells out on most of the things that may be important to both sides. To corrupt an already awkward metaphor, terminal sedation "pulls the sheet over our eyes." Terminal sedation may still be an important option in end-of life care, but it should not be presented as the only option in difficult deaths.

Proponents of assisted dying point to autonomy and mercy. The principle of autonomy holds that people are entitled to be the architects, as much as possible, of how they die. The principle of mercy requires that pain and suffering be relieved to the extent possible. These two principles operate in tandem to underwrite physician-assisted dying: physician assistance in bringing about death is to be provided just when the person voluntarily seeks it and just when it serves to avoid pain and suffering or the prospect of them. Both requirements must be met.

Opponents base their objections to physician-assisted dying on two other concerns. One is the sanctity of life, a religious or secular absolute respect for life that is held to entail the wrongness of killing, suicide, or murder. This principled objection holds regardless of whether a patient seeks assistance in dying in the face of pain and suffering. The second objection is that physician-assisted dying might lead to abuse. This concern is often spelled out in two ways: physician-assisted dying risks undercutting the integrity of the medical profession, and institutional or social pressures might make people victims of assisted dying they did not want.

Terminal sedation is often proffered as an alternative last resort measure that can overcome these practical and ideological disputes. In the 1997 cases of Washington v. Glucksberg and Vacco v. Quill, the Supreme Court recognized the legality of providing...

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