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Outcome:
By the end of this activity, you will be able to define terminal sedation and compare and contrast it with PAS.
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Preparation
It seems that many individuals are still uncomfortable with PAS, and rightfully so. It is an option that could lead to horrible abuses in healthcare, though if it is done right, it may be the ultimate expression in autonomy. Please consider the following quote:
“Many times, however, a person may be terminally ill and suffering yet not be dependent on any form of life-sustaining medical treatment [(i.e. respirator, artificial nutrition and hydration, etc.)]. . . .Such persons thus obtain no benefit from the “negative” right to be free from unwanted care . . . [and] may want someone’s assistance to help them die, assuming they are unwilling to use a gun, or stop eating and drinking . . . . It is certainly not obvious why a person’s ability to end her life with the assistance of her doctor should be determined by the “luck” of having the type of disease that conveniently makes her dependent on some form of life-sustaining treatment.”
Jerry Menikoff, Law and Bioethics: An Introduction 327 (2001)
Such “unlucky” diagnoses include cancer, AIDS, Huntington’s, or any one of a number of other diseases that causes the slow degeneration of your body.
Terminal sedation seems to provide a loophole for physicians who are conflicted about their duty to heal and subscription to the Hippocratic Oath. Termination sedation occurs when the provision of necessary medication (i.e. morphine for pain) is given to relieve the patient?s suffering, but also depresses the respiratory (or cardiac or whatever) system, leading to the death of the patient. As the medication was given with the intended consequence of pain relief, and not death, nothing immoral has occurred pursuant to the principle of double effect.
However, when push comes to shove, what are the true differences between PAS and terminal sedation, the latter of which is justified by the principle of double effect?
The New York State Task Force on Life and the Law has said:
“It is widely recognized that the provision of pain medication is ethically and professionally acceptable even when the treatment may hasten the patient’s death, if the medication is intended to alleviate pain and severe discomfort, not to cause death . . . According to [the principle of double effect], an action with both good and evil effects is permitted if the action is not intrinsically wrong, the agent intends only the good and not the evil effect, the evil effect is not the means to the good effect, and there is a favorable balance between the good and evil effects . . . The administration of medication is not intrinsically wrong and is intended to alleviate the patient’s pain, not to hasten the patient’s death, although the risk of death could be anticipated. Respiratory failure is not intended, nor is it necessary to relieve pain. In addition, because the patient is terminally ill and experiencing severe pain, the good achieved would outweighed the risk of harm.”
New York Task Force on Life and the Law, When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context, 163 (1994).
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?Is terminal sedation the solution to respecting a patient’s autonomy, the deontological duties of a physician, and the utilitarian goals of patients that are terminally ill? Or, is this a totally paternalistic procedure that has no place in medicine?
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