1.Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.
Tze Ling Gwendoline Beatrice SOH ; Lalit Kumar Radha KRISHNA ; Shin Wei SIM ; Alethea Chung Peng YEE
Singapore medical journal 2016;57(5):220-227
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.
Analgesics, Opioid
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therapeutic use
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Attitude of Health Personnel
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Death
;
Deep Sedation
;
ethics
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Ethics, Medical
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Euthanasia
;
ethics
;
legislation & jurisprudence
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Humans
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Hypnotics and Sedatives
;
therapeutic use
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Palliative Care
;
ethics
;
Personhood
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Philosophy, Medical
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Practice Guidelines as Topic
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Suicide, Assisted
;
ethics
;
legislation & jurisprudence
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Terminal Care
;
ethics
;
Unconsciousness