Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.
- Author:
Tze Ling Gwendoline Beatrice SOH
1
;
Lalit Kumar Radha KRISHNA
1
;
Shin Wei SIM
1
;
Alethea Chung Peng YEE
1
Author Information
- Publication Type:Journal Article
- Keywords: Ring Theory of Personhood; continuous sedation until death; palliative care; personhood; terminal sedation
- MeSH: Analgesics, Opioid; therapeutic use; Attitude of Health Personnel; Death; Deep Sedation; ethics; Ethics, Medical; Euthanasia; ethics; legislation & jurisprudence; Humans; Hypnotics and Sedatives; therapeutic use; Palliative Care; ethics; Personhood; Philosophy, Medical; Practice Guidelines as Topic; Suicide, Assisted; ethics; legislation & jurisprudence; Terminal Care; ethics; Unconsciousness
- From:Singapore medical journal 2016;57(5):220-227
- CountrySingapore
- Language:English
- Abstract: Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death.
