Compassion and respect

Terminal sedation – ethically different from voluntary assisted dying?

The Q&A program on Monday night has prompted a valuable debate on a range of specific issues raised in the program. This is being conducted through the Q&A Facebook page.

The issue that has attracted the largest number of comments is terminal sedation.  In the Q&A program, John Flynn asked: “My wife Jennie suffered from a cancer next to her spine. After multiple surgery and experimental drugs. The pain was overwhelming for more than 2 years. Then in palliative care under sedation with opiates, Jennie received no food or water for 14 days to accelerate her death, legally. How can starvation and dehydration be the best option to end life?”

We don’t believe it is and find it ethically unacceptable.  We do not believe there is any ethical difference between terminal sedation to end suffering when everyone knows it will hasten the end of the person’s life and voluntary assisted dying to end suffering when everyone knows it will end the person’s life. But there is an ethical difference between a long drawn out death (days or weeks) with the family and loved ones having to stand by helplessly, and allowing a quick, peaceful, chosen death, where you want and with the loved ones you want with you at the end.

Many people are not aware that terminal sedation (also called palliative sedation or palliative sedation therapy) is the method used by palliative care doctors when patients have what the doctors regard as ‘refractory symptoms’ but which we would describe as intolerable suffering that is otherwise unrelievable.  It involves drugs being given to patients to put them into a coma.  The dosage is then gradually increased to maintain them in that state without food or water until they die.  This can take days or even weeks as demonstrated by John Flynn.

A recent study in the Journal of Palliative Medicine found that, although “palliative sedation therapy is increasingly used in end-of-life care … consensus about definitions, indications, and treatment decision making is lacking”.  Some people who are suffering terribly get it, some don’t!

The method is generally regarded as hastening the person’s death, though some dispute that it does.  The other major claim, made particularly by the AMA, doctors and palliative care organisations opposed to voluntary assisted dying law reform, is that terminal sedation is ethically acceptable.  They argue terminal sedation is not ‘euthanasia’ because the doctors’ primary intention is to relieve suffering and the patient’s death is not the intention – even though it is clearly foreseen by the doctors.

Where voluntary assisted dying laws exist and when we get our own, those who find an ethical difference between terminal sedation and voluntary assisted dying or those who see no difference will be able to act according to our own consciences.  We won’t have one view forced on us.

 

 

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Dying with Dignity Tasmania

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