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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
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.
Bibliography
Carel, H. 2008. Illness. Acumen Publishing.
Cassell, E.J. 2003. The nature of suffering and the goals of medicine. Oxford, UK: Oxford University Press.
Cassell, E.J., and B.A. Rich. 2010. Intractable end-of-life suffering and the ethics of palliative sedation. Pain Medicine 11: 435–438. https://doi.org/10.1111/j.1526-4637.2009.00786.x.
Claessens, P., J. Menten, P. Schotsmans, and B. Broeckaert. 2008. Palliative sedation: A review of the research literature. Journal of Pain and Symptom Management 36: 310–333.
Cowan, J.D., and D. Walsh. 2001. Terminal sedation in palliative medicine—definition and review of the literature. Support Care Cancer 9: 403–407.
Coyle, N. 2004. The existential slap—A crisis of disclosure. International Journal of Palliative Nursing 10: 520. https://doi.org/10.12968/ijpn.2004.10.11.17130.
Craig, G. 2005. Sedation without hydration can seriously damage your health. International Journal of Palliative Nursing 11: 333–337. https://doi.org/10.12968/ijpn.2005.11.7.18485.
Emmerich, N. 2018. Leadership in palliative medicine: Moral, ethical and educational. BMC Medical Ethics 19: 55. https://doi.org/10.1186/s12910-018-0296-z.
Emmerich, N., and B. Gordijn. 2019. Ethics of crisis sedation: Questions of performance and consent. Journal of Medical Ethics medethics-2018-105285. https://doi.org/10.1136/medethics-2018-105285.
Enck, R.E. 1991. Drug-induced terminal sedation for symptom control. The American Journal of Hospice & Palliative Care 8: 3–5.
Holm, S. 2013. 14 – terminal sedation and euthanasia: The virtue in calling a spade what it is. In Continuous sedation at the end of life: Ethical, clinical and legal perspectives, ed. S. Sterckx, K. Raus, and F. Mortier. Cambridge, UK: Cambridge University Press.
Horn, R. 2018. The ‘French exception’: The right to continuous deep sedation at the end of life. Journal of Medical Ethics 44: 204–205. https://doi.org/10.1136/medethics-2017-104484.
Jones, D.A. 2013a. Death by equivocation: A manifold definition of terminal sedation. In Continuous sedation at the end of life: Ethical, clinical and legal perspectives, ed. S. Sterckx, K. Raus, and F. Mortier. Cambridge, UK: Cambridge University Press.
———. 2013b. 3 – Death by equivocation: A manifold definition of terminal sedation. In Continuous sedation at the end of life: Ethical, clinical and legal perspectives, ed. S. Sterckx, K. Raus, and F. Mortier. Cambridge, UK: Cambridge University Press.
Maltoni, M., C. Pittureri, E. Scarpi, et al. 2009. Palliative sedation therapy does not hasten death: Results from a prospective multicenter study. Annals of Oncology 20: 1163–1169. https://doi.org/10.1093/annonc/mdp048.
Maltoni, M., E. Scarpi, M. Rosati, et al. 2012. Palliative sedation in end-of-life care and survival: A systematic review. JCO 30: 1378–1383. https://doi.org/10.1200/JCO.2011.37.3795.
McCartney, M. 2012. The assault on the Liverpool care pathway. BMJ 345: e7316–e7316. https://doi.org/10.1136/bmj.e7316.
Mercadante, S., G. Intravaia, P. Villari, et al. 2009. Controlled sedation for refractory symptoms in dying patients. Journal of Pain and Symptom Management 37: 771–779. https://doi.org/10.1016/j.jpainsymman.2008.04.020.
Morita, T., I. Maeda, M. Mori, et al. 2016. Uniform definition of continuous-deep sedation. Lancet Oncology 17: e222.
Morita, T., S. Tsuneto, and Y. Shima. 2001. Proposed definitions for terminal sedation. Lancet 358: 335–336. https://doi.org/10.1016/S0140-6736(01)05515-5.
———. 2002. Definition of sedation for symptom relief: A systematic literature review and a proposal of operational criteria. Journal of Pain and Symptom Management 24: 447–453.
Rich, B.A. 1997. A legacy of silence: Bioethics and the culture of pain. Journal of Medical Humanities 18: 233–259. https://doi.org/10.1023/A:1025697920944.
Rowland, K., and S.-A. Schumann. 2010. Palliative care: Earlier is better. The Journal of Family Practice 59: 695–698.
Savulescu, J., and J. Radcliffe-Richards. 2019. A right to be unconscious. Anaesthesia. https://doi.org/10.1111/anae.14635.
Sterckx, S., K. Raus, and F. Mortier, eds. 2013. Continuous sedation at the end of life: Ethical, clinical and legal perspectives. Cambridge University Press.
Taboada, P. 2015. Sedation at the end of life. Clinical realities, trends and current debate. In Sedation at the end-of-life: An interdisciplinary approach, 1–14. Dordrecht: Springer.
ten Have, H., and J.V. Welie. 2014. Palliative sedation versus euthanasia: An ethical assessment. Journal of Pain and Symptom Management 47: 123–136.
van Delden, J.J.M. 2007. Terminal sedation: Source of a restless ethical debate. Journal of Medical Ethics 33: 187–188. https://doi.org/10.1136/jme.2007.020446.
Wrigley, A. 2014. Ethics and end of life care: The Liverpool care pathway and the Neuberger review. Journal of Medical Ethics Medethics-2013-101780. https://doi.org/10.1136/medethics-2013-101780.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this chapter
Cite this chapter
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
Download citation
DOI: https://doi.org/10.1007/978-3-030-86386-9_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-86385-2
Online ISBN: 978-3-030-86386-9
eBook Packages: Religion and PhilosophyPhilosophy and Religion (R0)