Palliative Sedation is a medical treatment used to treat intractable pain in terminally ill patients. The intent, both ethically and legally, is to alleviate pain that is not manageable by any other means. The intent is NOT to end the patient’s life. Moreover, Palliative Sedation is not a paternalistic practice; a doctor cannot order Palliative Sedation without the consent of the patient or the patient’s surrogate. The strict standards are probably somewhat akin to “requiring” a patient to sign a DNR. Such a practice is not only ethically ill-conceived, it is legally forbidden.

In the Netherlands, though not in the US, Euthanasia–the act of injecting a lethal dose of medication intentionally to end a patient’s life– is condoned legally and ethically. Nevertheless, there as here, there is growing concern that the line between Palliative Sedation and Euthanasia has grown increasingly blurry. Many are concerned that the permitted practice in the Netherlands of both procedures has led to a loose interpretation and a lax attitude in terms of consent, leading to involuntary Euthanasia.

Contributing to the fear, requests for Euthanasia in the Netherlands increased 40% between 2005 and 2010. (Olsen, 2010). There is also a significant increase in the number of doctors willing to perform Euthanasia. Of concern is that the increase in the number of deaths appears related to physicians inappropriately inducing continuous deep sedation with the intention of inducing death, in direct contrast to the legal requirements for administering palliative sedation for pain control. Equally concerning is that the practice, under the misunderstood guise of Palliative Sedation is being performed without consent.

Actual discussion questions:

Read the following and then proceed to the discussion:

Please read the short scenario and respond to the following question:

An 85-year old terminal patient with stage IV cancer and virtually intractable pain undergoes surgery to remove a malignant mass pressing on his spinal cord. Although the hope is that the surgery will stave off paralysis and relieve his pain, there is a good chance the patient will die during or immediately following surgery.

  • Is this scenario ethically equivalent to the rationale behind Palliative Sedation? Why or Why Not? Please explain your response, using the ethical theories and principles we have discussed throughout the course as appropriate.

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