Terminal Sedation: A Substitute for Euthanasia?

  • Torbjörn Tännsjö
Chapter

Abstract

By ‘terminal sedation’ I denote, in the present chapter, a procedure where through heavy sedation a terminally ill patient is put into a state of coma, where the intention of the doctor is that the patient should stay comatose until he or she is dead. No extraordinary monitoring of the medical state of the patient is undertaken. Normal hydration is ignored. All this means that in some cases where patients are being terminally sedated, death is hastened; if the disease does not kill the patient, some complication in relation to the sedation, or the withdrawal of treatment and hydration, or the combination of these, does.

Keywords

Hydration Morphine Dehydration Ketamine Midazolam 

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Notes

  1. 1.
    The example is presented in, and is followed by, a discussion in several issues of the journal. See also the selective bibliography of the literature since 1990.Google Scholar
  2. 2.
    Gillian M. Craig, ‘On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far?’, Journal of medical ethics, Vol. 20, 1994: 139–143.CrossRefGoogle Scholar
  3. 3.
    R.J. Dunlop, J.E. Ellershaw, M.J. Baines, N. Sykes, and C.M. Saunders, ‘On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A reply’, Journal of Medical Ethics, Vol. 21. 1995: 141–143.CrossRefGoogle Scholar
  4. 4.
    Lawrence J. Schneiderman, ‘Is it morally justifiable not to sedate this patient before ventilator withdrawal’ The Journal of Clinical Ethics Vol 2 1991: 129–130Google Scholar
  5. 5.
    Many philosophers have attempted to make this kind of distinction, most ingenious among them all, Jonathan Bennett. But in my opinion even Bennett fails. Those who want to check this assessment of mine should read his most recent treatment of the subject, which can be found in his book, The Act Itself (Oxford: Oxford UP, 1995), chapters 4 through 8.Google Scholar
  6. 6.
    An authoritative statement of the principle of double effect can be found in New Catholic Encyclopedia, McGraw-Hill, New York, 1967.Google Scholar
  7. 7.
    Airedale NHS Trust v. Bland (1993).Google Scholar
  8. 8.
    ‘The Additive Fallacy’, Ethics, 1988:5–31Google Scholar
  9. 9.
    American Association for Hospice and Palliative Medicine, Position statement on the end-of-life, Appendix of this volume, p. 128.Google Scholar
  10. 10.
    ‘Palliative Options of Last Resort’, JAMA, Vol. 278, 1997. In this book reprinted as Chapter 1. p. 6.Google Scholar
  11. 11.
    Ibid., p. 7.Google Scholar
  12. 12.
    Ibid., pp. 7–8.Google Scholar
  13. 13.
    ‘Is Sedation Without Hydration or Nourishment in Terminal Care Lawful?’, Medico-Legal Journal, Vol. 62, 1994:200.Google Scholar
  14. 14.
  15. 15.
    At a meeting held at The National Board of Health and Welfare on Oct. 29. 1997.Google Scholar
  16. 16.
    Håkan Samuelsson and Eva Thornberg, ‘Symptomlindring inte dödshjälp’ (Symptom control is not euthanasia), Göteborgs-Posten. January 1. 1998.Google Scholar
  17. 17.
    This description it taken from M. O’Connor, D.W. Kissane, and O. Spruyt, ‘Sedation of the terminally ill — a clinical perspective’ Monash Bioethics Review. Vol 18 1999 n 22Google Scholar
  18. 18.
    Dag Lundberg, Psykologiska och etiska aspekter’ (Psychological and Ethical Aspects), in Matts Halldin and Sten G. Lindahl (eds.), Anestesi (Anaesthesia) (Stockholm: Liber, 1999), p 190. My own translation.Google Scholar
  19. 19.
    ‘Sedation Before Ventilator Withdrawal: Medical and Ethical Considerations’, The Journal of Clinical Ethics, Vol. 2, 1991:127.Google Scholar
  20. 20.
    Guidelines on palliative sedation adopted by the Norwegian Medical Association, Appendix of this volume, p. 132–133.Google Scholar
  21. 21.
    ‘Morphine Drips, Terminal Sedation, and Slow Euthanasia: Definitions and Facts, Not Anecdotes’, Journal of Palliative rare Vnl 1 1996.3dGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2004

Authors and Affiliations

  • Torbjörn Tännsjö
    • 1
  1. 1.Department of PhilosophyStockholm UniversitySweden

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