Terminal sedation

Terminal sedation is the practice of inducing unconsciousness in a terminally ill person for the remainder of the person's life, usually by means of a continuous intravenous or subcutaneous infusion of morphine or other opioid drugs and benzodiazepines. In practice (though not by definition) this implies that the patient is not receiving any nutrition or other life-sustaining therapy while sedated.

Related Topics:
Intravenous - Subcutaneous - Morphine - Opioid - Benzodiazepine - Life-sustaining therapy

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There is no evidence that titrated sedation causes the death of the patient and sedation does not equate with euthanasia. At the end of life sedation is only used if the patient perceives their distress to be unbearable, and there are no other means of releving that distress. In palliative care the doses of sedatives or opioids are titrated to keep the patient comforatble without compromising respiration. There is extensive experience and several studies to show that opioid drugs such as morphine are not fatal as long as the dose is adjusted to keep the patient's respiratory rate from dropping too low—as continuous sedation orders require—and sedation by itself can actually prolong life to some degree, by relieving respiratory distress and strain on the heart. Death results naturally from the pre-existing disease process.

Related Topics:
Euthanasia - Palliative care

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Patients (or their legal representatives) do have the right to refuse life-sustaining treatment (such as with a living will), which is legally considered neither euthanasia nor suicide. However, once unconsciousness begins, the patient is no longer able to decide to stop the sedation or to request food or water and the clinical team need to act in the patient's best interests. As sedation and opioids are titrated to avoid harm (including death), there is no legal or ethical uncertainty in a treatment which is purely for comfort. Consequently, terminal sedation is generally considered legal and acceptable, as belonging to normal medical practice, even in jurisdictions where euthanasia and physician-assisted suicide are not.

Related Topics:
Living will - Suicide

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