Transcript Slide 3 Ethical Issues Around the Practice of Terminal Sedation

Sarah E. Shannon, PhD, RN
Topics in Medical Therapy: Terminal Sedation
Ethical Issues Around the Practice of Terminal Sedation
© Copyright By Sarah E. Shannon
Ethical Issues Around the Practice of Terminal Sedation
Topics in Medical Therapy:
Terminal Sedation
The definition of what constitutes terminal
sedation does not have universal agreement
but most consider it to be providing sedation
that achieves a state of unconsciousness while
maintaining a respiratory drive for a period
prior to the patient's death.
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Ethical Issues Around the Practice of Terminal Sedation
Background Issues
• Terminal sedation is legal in America.
• Study of physicians and nurses: 79% believed
terminal sedation was sometimes necessary to
treat intractable distress in dying patients and
77% reported using it in the past year.
• Terminal sedation is distinct from euthanasia in
that it is viewed as a tool for the management
of intractable symptoms of suffering rather
than as a tool to elicit death.
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Ethical Issues Around the Practice of Terminal Sedation
Reasons for Not Using
Terminal Sedation
• Fear of being accused of assisting suicide, mercy
killing, or euthanasia particularly when it is against
moral beliefs.
• Belief that certain types of suffering should be treated
with terminal sedation while others should not; i.e.,
physical pain versus existential suffering.
• Belief that being conscious has great value during the
last days or weeks of life.
• Terminal sedation may hasten death through
immobility.
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Ethical Issues Around the Practice of Terminal Sedation
Reasons for Using
Terminal Sedation
• To aggressively treat suffering whether it
is physical or existential suffering.
• Remove a patient’s justifiable fear of pain
at death and reassure them that they will
not be forced to die in pain even if it
means that they will be sedated to
unconsciousness.
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