Should Sedation Be Terminal?

• Author: Valko, Nancy
• Position: Abstracts

Nancy Valko, Should Sedation Be Terminal? 2 NAT'L CATH. BIOETHICS Q. 601 (2002).

Terminal sedation (TS) has become an important but controversial issue in bioethics during the last several years, especially in light of the ongoing debate about assisted suicide. TS has been both condemned and embraced by people on either side of the assisted suicide debate. It has been called an ethical form of end-of-life care, a legal alternative to assisted suicide, and "slow euthanasia."

Supporters define TS as the deliberate "termination of awareness" for "relief of intractable pain when specific pain relieving protocols or interventions are ineffective" and/or "relief of intractable emotional or spiritual anguish (existential suffering, psychological distress, emotional exhaustion)." Although deep sedation can be provided as a temporary respite, once the decision is made to provide TS, it is considered irrevocable as soon as the person is unconscious. TS is then continued until death occurs.

The use of the word "terminal" has been eschewed by many supporters in favor of "total" or "palliative" because of the connotations that TS itself causes death or that the person must be imminently dying to receive TS. Commentators support more user-friendly terms like "palliative sedation" or another form of "comfort care" to describe permanent deep sedation for other categories of patients who have no substantial prospect of recovery."

An often crucial component of TS is the withholding or withdrawing of life-sustaining treatment, primarily food and water [assuring death within a short time], but routine medications such as insulin or blood pressure medicine are also rarely continued. But while there is universal agreement that treatment or care which is medically futile or excessively burdensome can be ethically forgone, TS itself does not depend on such determinations.

TS supporters point to the accepted principle of "double effect." The intention of the doctor is considered paramount, and the good effect of relieving unbearable suffering takes precedence over the bad effect of foreseen death. This is more than a little...