Should we all die asleep? The problem of the normalization of palliative sedation
Thursday, October 12, 2023
8:15 AM – 9:30 AM ET
Location: Heron (Fourth Floor)
Palliative sedation is a medical intervention to manage distress in dying patients, by reducing consciousness when symptom-directed therapies fail. Continuous deep sedation (CDS) is ethically sensitive, because it may shorten life and it completely prevents communication. But sedation short of this is also common. There has been a steady increase in the use of sedation over recent decades. The most recent (2021) figure from the Netherlands indicates that 23% of people died under CDS. Sedation may have become a means to die while sleeping, rather than a method of last resort to alleviate suffering. Sedation may be requested or expected, by patients, families or staff. The acceptance of a ‘tolerable amount of discomfort’ may have lost ground to a desire to get the final phase over with quickly.
Sedation is not always a bad thing. Medical care is otherwise unable to completely control all distressing symptoms in every patient. Sedation may result from other necessary symptom control drugs. Dying when sedated can be seen by as ‘peaceful’. We feel it is necessary, however, to highlight three caveats: the need to manage expectations, the cost in terms of loss of communication, and the grey area between continuous deep sedation and euthanasia.
We conclude that there may be good grounds for sedation in palliative care, and in some cases continuous deep sedation may be used as a last resort. But the criteria of necessary and proportionate drug treatment should remain. The normalization of sedation into dying while sleeping should be resisted.
Rowan Harwood – School of Health Sciences – University of Nottingham, Queens Medical Centre, UK; Madelon Heijltjes – Bioethics and Health Humanities – UMC Utrecht