Palliative sedation, foregoing life-sustaining treatment, and aid-in-dying: what is the difference?

Abstract

After a review of terminology, I identify-in addition to Margaret Battin's list of five primary arguments for and against aid-in-dying-the argument from functional equivalence as another primary argument. I introduce a novel way to approach this argument based on Bernard Lonergan's generalized empirical method (GEM). Then I proceed on the basis of GEM to distinguish palliative sedation, palliative sedation to unconsciousness when prognosis is less than two weeks, and foregoing life-sustaining treatment from aid-in-dying. I conclude (1) that aid-in-dying must be justified on its own merits and not on the basis of these well-established palliative care practices; and (2) that societies must decide, in weighing the merits of aid-in-dying, whether or not to make the judgment that no life is better than life-like-this (however this is specified) part of their operative value structure.

Palliative sedation and medical assistance in dying: Distinctly different or simply semantics?

“…Of note, survival was measured from time of admission or referral to time of death rather than time from onset of PS to time of death (Beller et al, 2015). What seems less contentious is that if given too early, PS may hasten death through the subsequent inability of the patient to eat or drink (Daly, 2015;Rhys et al, 2012;Twycross, 2017). What seems less contentious is that if given too early, PS may hasten death through the subsequent inability of the patient to eat or drink (Daly, 2015;Rhys et al, 2012;Twycross, 2017).…”

“…To illustrate, consider a patient who requests PS prior to voluntarily stopping eating and drinking (Daly, 2015); it is anticipated that death can occur within 1 to 3 weeks after a patient voluntarily stops eating and drinking (Quill et al, 1997). What about the patient's intent?…”

“…often ambiguous, and some have suggested that the meaning of intent may differ(Janssens et al, 2012;Juth et al, 2013;Quill et al, 1997;Rhys et al, 2012). For example, does intent reflect one's aim to hasten death or does intent reflect one's awareness of foreseeability(Daly, 2015)?The question of whether hastening death is an actual outcome of PS remains unclear. Studies have examined the potential for PS to hasten death and reported equivocal findings with some authors stating that PS does hasten death(Carvalho et al, 2011;Rady & Verheijde, 2010;Raus, Chambaere, & Sterckx, 2016) while others have found that PS does not hasten death(Maeda et al, 2016;Maltoni et al, 2012).…”

How defining clinical practices may influence their evaluation: the case of continuous sedation at the end of life

“…This definition is also used in the Flemish guideline on continuous sedation, and has been adopted by some other commentators [11].…”

Controversies surrounding continuous deep sedation at the end of life: the parliamentary and societal debates in France

“…This practice is the topic of considerable ethical debate [1–3]. Part of the controversy surrounding continuous sedation is related to its perceived similarity or dissimilarity to euthanasia and/or physician-assisted suicide (PAS) [4].…”