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Sedation in the imminently dying patient
1Department of Oncology, Shaarei Zedek Medical Center, Jerusalem, Israel.
Oncology (Williston Park, N.Y.)
|May 29, 2000
Summary
Terminal sedation effectively manages intractable symptoms in imminently dying patients. This crucial intervention aims to relieve suffering, not hasten death, upholding the physician's duty to do no harm.
Area of Science:
- Palliative Care
- Medical Ethics
Background:
- Patients with advanced, irreversible illnesses often experience intractable symptoms like pain, dyspnea, and delirium near end-of-life.
- Standard medical interventions may become ineffective for managing these refractory symptoms.
Purpose of the Study:
- To examine the role and ethical considerations of terminal sedation in managing intractable symptoms in imminently dying patients.
- To address concerns regarding terminal sedation as a surrogate for physician-assisted suicide or euthanasia.
Main Methods:
- Review of ethical arguments and clinical practice concerning terminal sedation.
- Application of the principle of double effect to differentiate intent from consequence in sedation.
Main Results:
- Terminal sedation is a clinically significant intervention for symptom relief in end-of-life care.
- Concerns exist that sedation may hasten death, but ethical frameworks support its use when intended to alleviate suffering.
Conclusions:
- Terminal sedation, when practiced by trained clinicians, is a necessary procedure to benefit patients and fulfill the obligation to "do no harm."
- The principle of double effect provides an ethical basis for distinguishing the intent to relieve suffering from the unintended consequence of hastening death.