The last low whispers revisited: a reply to Sulmasy on palliative sedation

Many ethicists who have opposed euthanasia have nonetheless approved of various practices which have been believed to hasten, or risk hastening, the death of terminally ill and suffering patients. For instance, they have approved of a practice which I shall call 'end-of-life sedation,' or 'EOL sedation.' This practice involves administering drugs with sedating effects to relieve suffering at the end of life. Some have believed that EOL sedation risks hastening death by suppressing respiration in certain cases. The main difference, according to these opponents of euthanasia, is that whereas euthanasia by definition involves an intention to kill, EOL sedation does not. At most, it is argued, EOL sedation foreseeably but unintentionally hastens, or risks hastening death as a byproduct of relieving the patient's suffering while they are still alive. As such, it has been argued that EOL sedation is supported by the rule of double effect (RDE). In his paper, "The last low whispers of our dead," Daniel P. Sulmasy raises objections to a specific form of EOL sedation called 'palliative sedation,' focusing especially on two variants of that practice which have been defended by Timothy Quill and colleagues. Palliative sedation involves intentionally sedating a patient as a means of relieving their suffering rather than foreseeably sedating them as a byproduct of targeting specific symptoms. Sulmasy argues that palliative sedation, so defined, is neither supported by RDE nor permissible. Here it is argued that Sulmasy's criticisms of this practice, and of the specific variants of it which he singles out for special criticism, are unsuccessful.