Continuous deep sedation until death: palliation or physician-assisted death?

Area of Science:

• Medical Ethics
• Palliative Care
• Clinical Pharmacology

Background:

• Distinguishing between palliative sedation and continuous deep sedation until death is crucial for ethical end-of-life care.
• Published literature lacks clarity on the effects of continuous deep sedation compared to standard palliative sedation.
• Continuous deep sedation is controversial, particularly when used for existential suffering or elective death requests.

Purpose of the Study:

• To differentiate the effects of continuous deep sedation until death from palliative sedation aimed at relieving distress.
• To analyze whether continuous deep sedation aligns with the principle of double effect in end-of-life care.
• To re-characterize continuous deep sedation in the context of physician-assisted death.

Main Methods:

• Literature review and ethical analysis of pharmacologically induced continuous deep sedation.
• Comparison of continuous deep sedation with common sedation practices for symptom relief in the final conscious phase of dying.
• Application of the principle of double effect to evaluate the intent and outcomes of continuous deep sedation.

Main Results:

• Continuous deep sedation predictably suppresses brainstem vital centers, leading to a life-shortening effect.
• The practice induces a permanent coma, which contravenes the double-effect principle due to its intended outcome and predictable consequences.
• Continuous deep sedation differs significantly from palliative sedation used to alleviate suffering in conscious patients.

Conclusions:

• Continuous deep sedation until death should not be equated with palliative care; it is ethically distinct and life-shortening.
• The practice contravenes the principle of double effect, as the intent to induce coma and the predictable life-shortening effect are primary.
• Continuous deep sedation should be classified as a form of physician-assisted death rather than a palliative measure.