George A. Sprecace M.D., J.D., F.A.C.P. and Allergy Associates of New London, P.C.

Point and Counterpoint: Abortion and Alternatives - Article 14, for Sunday, July 9, 2006

Palliative Sedation

In the last several years the term palliative sedation has come into use and has also been referred to, inaccurately, as total sedation, terminal sedation and slow euthanasia.  Because of its relevance to end of life decisions and the increasing incidence of its use, it will be discussed today. 

The Journal of the American Medical Association has this to say: “Terminal illnesses can cause distressing symptoms, such as severe pain, mental confusion, muscle spasms, feelings of suffocation, and agitation.  Despite skilled palliative care, in some cases these symptoms may not respond to standard interventions.  After all other means to provide comfort to a dying patient have been tried and are unsuccessful, doctors and patients can consider palliative sedation.  Palliative sedation is the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious (as in a deep sleep) while disease takes its course, eventually leading to death.  The sedative medication is gradually increased until the patient is comfortable and able to relax.  Palliative sedation is not intended to cause death or shorten life.”

This is also the position of the Hospice and Palliative Nurses Association which states: “Palliative sedation is the monitored use of medications intended to induce varying degrees of unconsciousness, but not death, for the relief of refractory and unendurable symptoms in imminently dying patients.”  This position is also supported by the American Nurses Association and their Code of Ethics for Nurses.

The basis of the position of the Catholic Church regarding mercy killing, euthanasia, physician assisted suicide and palliative sedation can be most succinctly stated as in the Catechism of the Catholic Church : “Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator.”  Accordingly, the crucial point is that in order to be a morally good decision the action or inaction chosen must not intend to end the patient’s life, but rather to control the patient’s suffering.  The decision to employ palliative sedation is a very serious one because it is a sedation from which the patient will most likely not awaken.  It should only be used in cases where the patient is imminently terminal and for whom no other treatment has been able to make them comfortable.  For the patient who does not leave instructions for this possible occurrence, the weight of the decision is thrust upon the family (whose thoughts may not be unanimous) or, in their absence, to the caregivers.  Thus, the importance for each of us to have a living will or Advance Directive with Power of Attorney for Healthcare.

Peter Moore, PhD    George A. Sprecace, M.D., J.D.

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