Abstract
This chapter considers a number of ethical issues that are raised by sedation at the end of life (also known as palliative sedation or terminal sedation). The first sections consider terminology and whether or not some sedation practices are life-shortening. Later sections analyse whether all kinds of suffering are valid indications for sedation at the end of life, and the relation between sedation and other end of life practices such as assisted suicide and euthanasia. It is argued that whereas sedation at the end of life is in some ways distinct from other end of life practices, there are also significant overlaps in intentions and aims pursued.
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Notes
- 1.
In this section to ‘justify’ means to ‘fulfil the part of the full justification of sedation at the end of life that is dependent on suffering.’ Whether or not ‘suffering’ alone is a sufficient justification and not merely a necessary part of the sufficient justification is discussed elsewhere in the chapter.
- 2.
I am using the terms ‘existential suffering’ and ‘existential distress’ as synonyms, although some others distinguish between them (Schuman-Olivier et al. 2008). I believe that my usage is consistent with the majority of the literature. It is of course possible to have existential questions or issues without these leading to suffering and/or distress.
- 3.
Healthcare professionals possess expertise in how to sedate, but not in whether to sedate. The fact that they know in what circumstances not to sedate, i.e. when there are other and better ways of dealing with symptoms and suffering than sedation (e.g. we do not sedate for ‘man flu’), does not show that they have any particular expertise in relation to when suffering that can only be relieved by sedation becomes so severe that sedation should be initiated.
- 4.
We are here ignoring the possibility of conscious experiences in the afterlife something that will not be obviated or otherwise impacted by the use of terminal sedation in any event.
- 5.
McGee and Gardiner have recently argued that in determining cardiac death what matters is not irreversibility but permanence, and that the relevant conception of permanence includes those cases where it has been decided not to use a particular intervention (McGee and Gardiner 2018). On their view we are right in claiming that the patient with a do-not-resuscitate order died at the moment when her heart stopped. The cessation of heart function was not irreversible at that point, but it was permanent given that we knew that resuscitation would not be attempted. This supports the line of argument outlined here.
- 6.
- 7.
On the Doctrine of Double Effect see Woods and Graven Chap. 12, this volume
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Holm, S. (2020). The Ethics of Sedation at the End of Life. In: Emmerich, N., Mallia, P., Gordijn, B., Pistoia, F. (eds) Contemporary European Perspectives on the Ethics of End of Life Care. Philosophy and Medicine, vol 136. Springer, Cham. https://doi.org/10.1007/978-3-030-40033-0_17
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