Expanding the Use of Continuous Sedation Until Death: Moving Beyond the Last Resort for the Terminally Ill

Samuel H LiPuma; Joseph P DeMarco

Expanding the Use of Continuous Sedation Until Death: Moving Beyond the Last Resort for the Terminally Ill

J Clin Ethics. 2015 Summer;26(2):121-31.

Authors

Samuel H LiPuma¹, Joseph P DeMarco²

Affiliations

¹ Cuyahoga Community College, Western Campus, Department of Philosophy, 11000 Pleasant Valley Rd., Parma, OH 44103-5150 USA. [email protected].
² Cleveland State University, Department of Philosophy, 2121 Euclid Ave., RT 1932, Cleveland, Ohio 44115-2214 USA.

PMID: 26132059

Abstract

As currently practiced, the use of continuous sedation until death (CSD) is controlled by clinicians in a way that may deny patients a key choice in controlling their dying process. Ethical guidelines from the American Medical Association and the American Academy of Pain Medicine describe CSD as a "last resort," and a position statement from the American Academy of Hospice and Palliative Medicine describe it as "an intervention reserved for extreme situations." Accordingly, patients must progress to unremitting pain and suffering and reach a last-resort stage before the option to pursue CSD is considered. Alternatively, we present and defend a new guideline in which decisionally capable, terminally ill patients who have a life expectancy of less than six months may request CSD before being subjected to the refractory suffering of a treatment of "last resort."

Publication types

Case Reports

MeSH terms

Choice Behavior / ethics
Death
Decision Making / ethics*
Deep Sedation / ethics*
Euthanasia, Active, Voluntary / ethics
Euthanasia, Active, Voluntary / legislation & jurisprudence
Euthanasia, Active, Voluntary / trends
Health Personnel / ethics
Health Personnel / legislation & jurisprudence
Health Personnel / psychology
Hospice Care / ethics
Humans
Informed Consent / ethics
Informed Consent / standards
Life Expectancy
Lung Neoplasms / pathology
Male
Middle Aged
Moral Obligations
Netherlands
Pain / etiology
Pain Management / ethics*
Pain Measurement
Palliative Care / ethics*
Palliative Care / methods
Palliative Care / trends
Patient-Centered Care / ethics*
Patient-Centered Care / methods
Patient-Centered Care / trends
Personal Autonomy*
Practice Guidelines as Topic
Public Opinion
Social Values
Spinal Neoplasms / complications
Spinal Neoplasms / secondary
Stress, Psychological / prevention & control
Suicide, Assisted / ethics
Suicide, Assisted / legislation & jurisprudence
Suicide, Assisted / trends
Terminal Care / ethics*
Terminal Care / methods
Terminal Care / trends
Terminally Ill*
Time Factors
Treatment Refusal*
Truth Disclosure / ethics
Uncertainty
United States
Withholding Treatment / ethics