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„Terminale Sedierung“

Ausweg im Einzelfall, Mittelweg oder schiefe Ebene?

“Terminal sedation”

Way out, compromise or slippery slope in the management of intractable suffering?

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Zusammenfassung

Die Medikalisierung des Sterbens hat dazu geführt, dass ein „guter Tod“ zunehmend auch von medizinischen Interventionen erwartet wird. Die Möglichkeiten einer „terminalen Sedierung“ bis zum Tode werden von vielen als Ausweg angesehen, wenn bei unerträglichem Leid und aussichtsloser Prognose der Wunsch nach aktiver Sterbehilfe angesprochen wird. Durch eine Sedierung können zwar bei schwerstkranken Patienten schwerste therapierefraktäre Leidenszustände effektiv gelindert werden. Diese Therapieoption kann aber auch in der Absicht angewendet werden, den Todeseintritt medizinisch zu beschleunigen, so dass im Zusammenhang mit der Euthanasiedebatte auch das Thema der terminalen Sedierung kontrovers diskutiert wird. Richtlinien zu Indikation, Technik und Dokumentation sind notwendig, um Stellenwert und Grenzen der terminalen Sedierung im Rahmen der palliativen Betreuung am Lebensende zu verdeutlichen und durch Transparenz Fehlentwicklungen zu vermeiden.

Abstract

Definition of the problem: The medicalisation of dying has increased the influence of medical interventions on the dying process and fuelled the discussion on the medical contributions for a “good death”. From an ethical point of view terminal sedation seems to be a way out when in intolerable suffering or situations without prospects the demand for euthanasia arises.

Arguments and conclusion: Terminal sedation can be used not only for effective control of otherwise refractory suffering but also with the intention to hasten death. This has led to ethical concerns on the use and limits of sedation, especially when patients demand continuous sedation until death. Clear guidelines on indication, techniques and documentation are needed to clarify the position of terminal sedation in end-of-life care to prevent misuse.

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  1. Abt. f. Anästhesiologie, Palliativmedizin und Schmerztherapie, Gemeinschaftskrankenhaus Havelhöhe, Berlin

    H. Christof Müller-Busch

  2. Abt. f. Anästhesiologie, Palliativmedizin und Schmerztherapie, Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin

    H. Christof Müller-Busch

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Correspondence to H. Christof Müller-Busch.

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Müller-Busch, H.C. „Terminale Sedierung“. Ethik Med 16, 369–377 (2004). https://doi.org/10.1007/s00481-004-0326-x

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