Should We Expand Continuous Sedation Practices at the End of Life? Ethical Insights from Dame Cicely Saunders, Founder of the Modern Hospice Movement
Thursday, October 12, 2023
4:00 PM – 5:15 PM ET
Location: Heron (Fourth Floor)
Continuous sedation, sometimes called palliative or terminal sedation, is an option of last resort for patients experiencing refractory symptoms at the end of life. It is ethically controversial because it reduces, and sometimes obliterates, a patient’s conscious awareness prior to death. After three decades of debate, there is a broad professional and ethical consensus that continuous sedation is permissible for patients who are suffering from refractory symptoms during the final stages of terminal illness (i.e., prognosis less than two weeks).
In a recent article, Gilbertson and colleagues argue that continuous sedation should be expanded in jurisdictions in which assisted dying is legal. Specifically, they contend that continuous sedation ought to be permitted in four scenarios: in cases of non-refractory suffering; when the patient’s unconsciousness is clinically desired; when the patient satisfies all criteria for aid-in-dying; and when a patient’s prognosis is greater than two weeks and suffering is judged intolerable.
This paper critically analyzes this proposal by appealing to the ethical insights of an individual whose pioneering, interdisciplinary work in end-of-life care has been insufficiently appreciated in the field of bioethics: Dame Cicely Saunders, founder of the modern hospice movement. Selections from Saunders’s corpus will be used to engage Gilbertson et al.’s argument. Concluding remarks will offer suggestions for addressing end-of-life suffering in clinical practice.