Abstract
Given the extensive literature on the topic it seems clear that palliative sedation raises particularly challenging ethical questions. Nevertheless, Savulescu and Radcliffe-Richards (Anaesthesia. https://doi.org/10.1111/anae.14635, 2019) have recently suggested that patients not only have a right to be given analgesia and sedation in response to pain but also have a right to be rendered unconscious if and when this is required to effectively manage their pain. This essay follows a similar line of reasoning and suggests that the extensive ethical analysis of palliative sedation may result in an overabundance of ethical caution that has the potential to lead to patients suffering needlessly. Thus I offer a corrective and argue that the clinical needs of dying patients should be foregrounded. Furthermore, whilst existing ethical debates about various forms and facets of palliative sedation and, in particular, continuous deep sedation contain important points, it is nevertheless the case that the ethical imperative practicing healthcare professionals involved in end of life care should be most concerned with is the alleviation and management of pain and suffering.
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Notes
- 1.
I will have further comments on this notion of a right to unconsciousness and what it might entail.
- 2.
Whilst it is true to say that the concerns of palliative medicine are greater than end of life care, caring for dying patients does constitute a large part of the field (Emmerich 2018). Furthermore, the kinds of ethical issues that have concerned those who comment upon palliative sedation focus on dying patients. Thus, for the purposes of this paper, palliative care is equated with providing care at the end of life.
- 3.
Whether or not euthanasia or MAID falls within the bounds of palliative and / or terminal sedation is, like much else in this area, controversial. Whilst one can see both sides of the issue, given that we will not be considering any action that has the patient’s death as its aim in this chap. I will not be adopting a definitive position.
- 4.
Of course, the issue of hastening death is closely aligned with questions about causing death, but this latter concern is beyond the scope of this chapter.
- 5.
At this point it is worth referencing the notion of an existential slap, something that can form part of the patient’s experience when being given a terminal diagnosis (Coyle 2004).
- 6.
The example is chosen as the philosopher Havi Carel (2008) has written about her experiences of having LAM and theorized the nature of illness on this basis.
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Emmerich, N. (2022). Palliative Sedation – Is It a Real Dilemma?. In: Mallia, P., Emmerich, N., Gordijn, B., Pistoia, F. (eds) Challenges to the Global Issue of End of Life Care. Advancing Global Bioethics, vol 17. Springer, Cham. https://doi.org/10.1007/978-3-030-86386-9_12
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