Expanded terminal sedation in end-of-life care.

Area of Science:

• Medical Ethics
• Palliative Care
• End-of-Life Care

Background:

• Palliative care advances still leave some patients with significant end-of-life suffering.
• Terminal Sedation (TS) involves sedatives for dying patients, with limits on refractory symptoms, proportional dosing, and imminent death.
• Expanded TS (ETS) extends sedation use beyond these traditional limits.

Purpose of the Study:

• To explore and defend the moral permissibility of Expanded Terminal Sedation (ETS).
• To examine ETS in jurisdictions where assisted dying is lawful.
• To identify scenarios where ETS can bridge gaps in end-of-life care.

Main Methods:

• Ethical analysis and argumentation.
• Review of existing criteria for Terminal Sedation and assisted dying.
• Exploration of specific clinical scenarios for ETS application.

Main Results:

• ETS is argued to be morally permissible in cases of non-refractory suffering with likely treatment failure.
• ETS is considered appropriate when gradual sedation is ineffective or unconsciousness is desired.
• ETS may be permissible for patients eligible for assisted dying or those with prolonged suffering (over 2 weeks) where sedation is the best option.

Conclusions:

• ETS provides a viable option for patients experiencing intolerable suffering who are ineligible for TS or assisted dying.
• There is potential for convergence between criteria for assisted dying and ETS.
• ETS can help alleviate suffering for a broader range of dying patients.