Terminal Sedation – Good Medicine? Good Ethics? Good Law?

Abstract

The use of sedation at the end of life is becoming increasingly common, yet its ethics and lawfulness have not been as widely discussed as might have been expected.  In this article, the primary focus is on what is known as ‘terminal sedation’, with particular reference to the use of sedation without the provision of assisted nutrition and hydration (‘ANH’). It is argued that, where ANH is not contraindicated by patient wellbeing itself, close scrutiny of the practice is required.  There are both ethical and legal reasons why a move towards appropriate regulation is appropriate.  The urgency of doing this is evidenced by the variety in practices throughout the world, with some commentators suggesting that the decision whether or not to instigate terminal sedation may be influenced by more than clinical indications for its use (in which case, it may be perilously close to a form of euthanasia).  Indeed, it may be argued that there is little that differentiates terminal sedation from a form of euthanasia. Moreover, the relatively common exclusion of existential suffering as an indication for terminal sedation is questioned.  Were this also to be accepted as a valid indicator for terminal sedation (without the provision of ANH) it becomes even more urgent that an adequate regulatory framework is developed and that the ethics of the practice are appropriately explored and clarified.