A right to be unconscious

Savulescu, Julian; Radcliffe-Richards, J

doi:10.1111/anae.14635

Cited by 5 publications

(7 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Savulescu has highlighted the possibility of 'undershoot(ing)' during this process and subjecting the patient to a level of suffering that is unnecessary. 30 Furthermore, empirical studies suggest that sedated patients can still experience suffering despite appearing comfortable to the doctor, especially where the level of sedation is light, as is endorsed by GTS. 31 32 If lightly sedated patients cannot communicate their suffering, this brings into question the ability of doctors to recognise signs of symptom recurrence.…”

Section: Gradual Sedationmentioning

confidence: 99%

Expanded terminal sedation in end-of-life care

et al. 2022

View full text Add to dashboard Cite

Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one or more of these limits.In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We argue that ETS is morally permissible: (1) in cases of non-refractory suffering where earlier treatments are likely to fail, (2) where gradual sedation is likely to be ineffective or where unconsciousness is a clinically desirable outcome, (3) where the patient meets all criteria for assisted dying or (4) where the patient has greater than 2 weeks to live, is suffering intolerably, and sedation is considered to be the next best treatment option for their suffering.While remaining two distinct practices, there is scope for some convergence between the criteria for assisted dying and the criteria for ETS. Dying patients who are currently ineligible for TS, or even assisted dying, should not be left to suffer. ETS provides one means to bridge this gap.

show abstract

Section: Gradual Sedationmentioning

confidence: 99%

Expanded terminal sedation in end-of-life care

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Sería reduccionista considerar que el profesional médico sólo se centre en el manejo de los síntomas físicos que aquejan a su paciente y no procure, mediante este cuidado integral, la mejor calidad de vida posible. Esto es concordante con una visión más inclusiva de los fines de la medicina que considera como responsabilidad de los médicos acompañar a sus pacientes en esta última etapa, en que deciden terminar voluntariamente con sus vidas, sin abandonarlos y proveyendo los medios necesarios para que esta decisión sea tomada cumpliendo todos los requisitos que la validan ética y legalmente 10,34 , a la vez que asegurando que el desenlace ocurra con el menor sufrimiento posible y la menor posibilidad de error 40 .…”

Section: Argumentos a Favor De La Participación De Los Médicos En La Mmaunclassified

Argumentos éticos a favor y en contra de la participación del profesional médico en la muerte asistida. Análisis del Departamento de Ética del Colegio Médico de Chile

et al. 2020

View full text Add to dashboard Cite

Ethical arguments for and against the participation of the medical profession in assisted death: analysis of the Ethics Department of the Chilean Medical AssociationThe discussion of a bill that allows medically assisted death (MAD) in Chile, revived the debate about the ethics of this practice. The Department of Ethics of the Chilean Medical Association herein analyzes arguments in favor or against the participation of the medical profession in MAD. Among the main arguments against the participation of physicians in this practice are that MAD conflicts with the basic ethical principles of medical practice, that it is contrary to the purposes of medicine and that it could erode the patients' and society's confidence in physicians. The arguments in favor are related to physician´s compassion and non-abandonment of patients during their illness, choosing palliative care and ushering them to the final instance. Additionally, there is social expectation that this practice will be carried out by trained physicians who can verify that the strict criteria established by the legislation are met, guarantee that it obeys to a repeated request of a fully capable patient, and who is able to deal with the complications of the procedure. In this document we aimed to represent the different perspectives about physicians' participation in MAD, offering arguments to colleagues and stimulating their participation in this important debate.

show abstract

“…However, introducing general anaesthesia in end‐of‐life care also requires an examination of the associated ethical, medicolegal and practical implications. We stress that general anaesthesia in end‐of‐life care is not a form of assisted dying or euthanasia [ 1 , 2 ], which are illegal in the UK.…”

Section: Introductionmentioning

confidence: 99%

General anaesthesia in end‐of‐life care: extending the indications for anaesthesia beyond surgery

et al. 2021

Self Cite

View full text Add to dashboard Cite

Summary In this article, we describe an extension of general anaesthesia – beyond facilitating surgery – to the relief of suffering during dying. Some refractory symptoms at the end of life (pain, delirium, distress, dyspnoea) might be managed by analgesia, but in high doses, adverse effects (e.g. respiratory depression) can hasten death. Sedation may be needed for agitation or distress and can be administered as continuous deep sedation (also referred to as terminal or palliative sedation) generally using benzodiazepines. However, for some patients these interventions are not enough, and others may express a clear desire to be completely unconscious as they die. We summarise the historical background of an established practice that we refer to as ‘general anaesthesia in end‐of‐life care’. We discuss its contexts and some ethical and legal issues that it raises, arguing that these are largely similar issues to those already raised by continuous deep sedation. To be a valid option, general anaesthesia in end‐of‐life care will require a clear multidisciplinary framework and consensus practice guidelines. We see these as an impending development for which the specialty should prepare. General anaesthesia in end‐of‐life care raises an important debate about the possible role of anaesthesia in the relief of suffering beyond the context of surgical/diagnostic interventions.

show abstract

A right to be unconscious

Cited by 5 publications

References 1 publication

Expanded terminal sedation in end-of-life care

Expanded terminal sedation in end-of-life care

Argumentos éticos a favor y en contra de la participación del profesional médico en la muerte asistida. Análisis del Departamento de Ética del Colegio Médico de Chile

General anaesthesia in end‐of‐life care: extending the indications for anaesthesia beyond surgery

Contact Info

Product

Resources

About