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Mayo Clinic Review on differences between Palliative Sedation and other forms of end-of-life decisions

On the continuum of appropriate care at the end-of-life, Paliative Sedation (PS) has an important place. Health Care Professionals often voice concerns about the relationship to other end-of-life decisions, in particular to physician aid-in- dying (euthanasia and PAS).  In the Mayo Clinical Proceedings (October2010;85(10):949-954) clinicians Molly L. Olsen, Keith M. Swetz and Paul S. Mueller review the differentiation of PS from other forms of end-of-life decisions.

This review – clearly from an American juridical perspective (with only legal PAS in Oregon, Washington and Montana)- at the end presents a couple of clinical scenarios in which PS may be considered, hoping to contribute to  clarity on appropriate application.

The whole article may be seen by clicking here.

A comment on behalf of the Editorial board:

Since the late 1980s, palliative care has used sedative drugs in combination with opioids to produce deep and sustained unconsciousness until death, as the only means to control a range of refractory symptoms.  This was almost always associated with withholding of artificial nutrition and hydration.  It was applied in essentially the same circumstances where requests for physician aid in dying might be made.  It had the acknowledged potential, and in some cases actual effect, of hastening death.  It became known as ‘terminal sedation’, and later ‘deep continuous sedation’.  Many traditionalists in palliative care did not like these descriptors, and there has been a conscious attempt to delete them and use the term ‘palliative sedation’.  In addition, ‘terminal sedation’ has been subsumed into a number of more benign uses of sedatives (light, intermittent and short delivery) to confuse the rigourous examination of its effects.

There is nothing wrong with the principle of terminal sedation, and if this paper encourages its use to relieve otherwise intolerable suffering well and good.

The paper should be seen however as an attempt to sanitise the practise, to make the exaggerated claim that terminal sedation does not hasten death.  If one delays its full implementation until the patient is almost dead it will be difficult to detect any hastening – yet it clearly does so in some circumstances.  It also perpetuates the claim that its intent is different from voluntary euthanasia whose intent is claimed to be the termination of the patient’s life.  The intent of both acts is the same, namely the relief of suffering, although the outcome is different, though only in time. 

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