Palliative Sedation Versus Euthanasia: An Ethical Assessment

Abstract

The aim of this article was to review the ethical debate concerning palliative sedation. Although recent guidelines articulate the differences between palliative sedation and euthanasia, the ethical controversies remain. The dominant view is that euthanasia and palliative sedation are morally distinct practices. However, ambiguous moral experiences and considerable practice variation call this view into question. When heterogeneous sedative practices are all labeled as palliative sedation, there is the risk that palliative sedation is expanded to include practices that are actually intended to bring about the patients' death. This troublesome expansion is fostered by an expansive use of the concept of intention such that this decisive ethical concept is no longer restricted to signify the aim in guiding the action. In this article, it is argued that intention should be used in a restricted way. The significance of intention is related to other ethical parameters to demarcate the practice of palliative sedation: terminality, refractory symptoms, proportionality, and separation from other end-of-life decisions. These additional parameters, although not without ethical and practical problems, together formulate a framework to ethically distinguish a more narrowly defined practice of palliative sedation from practices that are tantamount to euthanasia. Finally, the article raises the question as to what impact palliative sedation might have on the practice of palliative care itself. The increasing interest in palliative sedation may reemphasize characteristics of health care that initially encouraged the emergence of palliative care in the first place: the focus on therapy rather than care, the physical dimension rather than the whole person, the individual rather than the community, and the primacy of intervention rather than receptiveness and presence.

Physician-assisted deaths in France: Results from a nationwide survey

“…The few cases where the responding physician's response on medical decisions corresponds to the definition of euthanasia in Belgium show that there is some vagueness in the characterisation of the medical practice by the physicians themselves. This confirms the results presented by ten Have [4], who found that they had trouble labelling their decisions, as is still the case among Belgian physicians even ten years after euthanasia was decriminalised [5,6]. In a context of the current debate about changes to the law, these results show that the most urgent priority is to intensify medical palliative education of all physicians, to develop LPM-2794 …”

Palliative Sedation—Still a Complex Clinical Issue!

“…Ethical perspectives on palliative sedation have added to the complexity, and it can sometimes be an intellectual challenge to follow the ethics specialists as they debate conflicting viewpoints [6][7][8] . Ten Have and Welie 7 recently published a review on the ethics debate about the difference between palliative sedation and euthanasia.…”

“…Ten Have and Welie 7 recently published a review on the ethics debate about the difference between palliative sedation and euthanasia. The dominant view is that these practices are morally distinct, but an alternative perspective contends that moral experience and practice variation can make the distinction questionable 7,8 . The need to use targeted education to help clinicians Curr Oncol, Vol.…”

Multi-Professional Medical Record on Continuous Palliative Sedation in an Inpatient Hospice: A Feasibility Pilot Study

“…CPS does not shorten the patient's life and should not be confused with euthanasia that is instead, the administration of drugs, under explicit request of a patient, at the aim to the intentional ending of his life. 6,10,11,[17][18][19][20][21][22][23][24][25][26][27] During CPS it is important to monitor the sedation, evaluating the patient's clinical condition, consciousness and refractory symptom control in order to establish the need to adjust the drug dosage. 2,11,28,29 A validation scale is recommended for this purpose.…”