Palliative Sedation, Forgoing Life-Sustaining Treatment, and Aid-in-Dying

Formerly referred to as “passive euthanasia,” forgoing life-sustaining medical treatment came to be accepted in the 1970s based on a patient’s right to privacy. In order to achieve this societal shift, the practice was clearly distinguished from active euthanasia, which was universally rejected. Over the ensuing decades, other permutations of “the right to die”—including receiving intensive pain medication at the end of life and palliative sedation—were considered and accepted to varying degrees. Modern advocates of euthanasia now argue that it is not, in fact, so different from forgoing life-sustaining medical treatment, which endangers the critical consensus that lies at the heart of the patient rights movement. Voluntarily stopping eating and drinking is also discussed, as well as the ethical equivalence of withdrawing and withholding life-sustaining treatment.

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Palliative Sedation, Compassionate Extubation, and the Principle of Double Effect: An Ethical Analysis

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909121998630 ◽

2021 ◽

pp. 104990912199863

Author(s):

Jordan Potter ◽

Steven Shields ◽

Renée Breen

Keyword(s):

Medical Practice ◽

Double Effect ◽

Palliative Sedation ◽

Ethical Analysis ◽

Respiratory Drive ◽

Clinical Scenario ◽

Ethical Justification ◽

Principle Of Double Effect ◽

Life Sustaining Treatment

Palliative sedation is a well-recognized and commonly used medical practice at the end of life for patients who are experiencing refractory symptoms that cannot be controlled by other means of medical management. Given concerns about potentially hastening death by suppressing patients’ respiratory drive, traditionally this medical practice has been considered ethically justifiable via application of the ethical doctrine known as the Principle of Double Effect. And even though most recent evidence suggests that palliative sedation is a safe and effective practice that does not hasten death when the sedative medications are properly titrated, the Principle of Double Effect is still commonly utilized to justify the practice of palliative sedation and any risk—however small—it may entail of hastening the death of patients. One less common clinical scenario where the Principle of Double Effect may still be appropriate ethical justification for palliative sedation is when the practice of palliative sedation is pursued concurrently with the active withdrawal of life-sustaining treatment—particularly the practice of compassionate extubation. This case study then describes an unconventional case of palliative sedation with concurrent compassionate extubation where Principle of Double Effect reasoning was effectively employed to ethically justify continuing to palliatively sedate a patient during compassionate extubation.

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Ethical issues in physician aid-in-dying

10.1093/med/9780198821328.003.0110 ◽

2021 ◽

pp. 1161-1169

Author(s):

Lars Johan Materstvedt

Keyword(s):

Palliative Care ◽

Assisted Suicide ◽

Ethical Issues ◽

Treatment Decisions ◽

Palliative Sedation ◽

Physician Assisted Suicide ◽

International Convention ◽

Aid In Dying ◽

Point Of Departure ◽

Normative Ethical Theory

According to international convention, physician aid-in-dying includes euthanasia and physician-assisted suicide, both of which are voluntarily requested forms of medicalized killings. In the former, a physician injects the patient with lethal drugs, whereas in the latter, the patient self-administers such drugs. The two practices differ fundamentally from non-treatment decisions and from the last-resort treatment, palliative sedation, and details of the differences are outlined in the chapter. Physician aid-in-dying differs considerably in appearance, depending on which normative ethical theory is taken as the point of departure and how various theories can be used either to reject or to defend physician aid-in-dying. The chapter also discusses alternative ways for palliative care physicians to relate to physician aid-in-dying.

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