Ethics & Med.: Pulling the Sheet Back Down: A Response to Battin on the Practice of Terminal Sedation.

• Author: Smith, Patrick T.
• Position: Abstracts - Reprint

In an intriguing and thought provoking essay entitled "Terminal Sedation: Pulling the Sheet Over Our Eyes," Margaret P. Battin argues that one cannot consistently affirm the practice of terminal or palliative sedation while at the same time rejecting physician-assisted death. She thinks that while there may be the feel that there is a moral difference between these two practices, its implausible defense rests on a tenuous appeal to the discerning of clinical intentions and a controversial application of double-effect reasoning. To be sure, she does not claim that the practice of terminal sedation is wrong. Instead, her issue is that it is often practiced disingenuously. The common features of the two practices are obscured or sanitized in professional discourse, Battin thinks, due to the anxiety that terminal sedation (the permissible strategy) might be confused with euthanasia and physician-assisted death (the impermissible strategy). This obfuscation is where it is claimed that "the sheet is pulled over our eyes" concerning the practice of terminal sedation.

Terminal patients are at the end of their lives, and terminal sedation is a palliative care technique used to care for terminal patients. Perhaps another way to put this is that the use of the word "terminal" is to describe the "when" of sedation, not the "why." This is the essence of terminal sedation: aggressive symptom control to the point of sedation in terminally ill patients.

Battin, however, seems to think that the purpose of termination sedation is to terminate the patient. This appears to be the evident assumption underlying many of her concerns. She writes:

The new euphemism, "palliative sedation," now often used instead of the more distressing "terminal sedation," only reinforces [the problem of patient consent being misdirected by focusing on avoiding pain and not on causing death which is where it should be]. By avoiding the word "terminal" and hence any suggestion that death may be coming, the most important feature of this practice is obscured and terminal sedation is confused with "palliative care." This seems to be a critical misunderstanding by Battin. The linguistic shift to "palliative sedation" that many now utilize is to clarify the intent and application of an often...