Terminal Sedation

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What is Terminal Sedation?

Terminal sedation (also known as deep sedation) is the medical practice of administering sufficient palliative drugs to render a patient unconscious.  This type of sedation is usually used only when lesser pain management is ineffective; the purpose is to relieve intense physical pain that usually occurs in advanced illnesses.  According to Nancy Guilfoy Valko, RN (a former hospice nurse), an essential part of terminal sedation is also the withdrawal of all treatment—including food and water—so that death occurs as soon as possible.  
 
Alex Schadenberg of the Euthanasia Prevention Coalition claims that terminal sedation can be used as a legitimate form of palliative care but is often abused as a slow form of euthanasia.  If nutrition and hydration are removed, then this measure is clearly being used as a type of euthanasia.  However, while patients suffering great pain can be ethically sedated to an unconscious state, nutrition and hydration should be continued.  Then, according to Schadenberg, after a short period, the patients should be “relaxed from their time of sedation and can be effectively treated for pain and symptom management without re-sedating them.”
 
Study from The Netherlands
A new study in The Netherlands has found an increase in terminal sedation and a decrease in euthanasia.  The study found that, of those who died, 1,800 people (7.1 percent of all deaths in the Netherlands in 2005) were drugged into continuous terminal sedation shortly before dying.  Just four years before, only 5.6 percent of people who died received terminal sedation.  During that same time, the use of euthanasia fell from 2.6 percent to 1.7 percent (a decrease in 1,200 cases).  Schadenberg suspects that the medical community reports instances of terminal sedation as a medical practice—which does not carry a moral stigma—rather than an act of euthanasia.
 
An Acceptable Form of Euthanasia?
Some euthanasia supporters see terminal sedation as inhumane compared to a quicker death by a lethal overdose.  However, some view terminal sedation as a way of circumventing prohibitions on physician-assisted suicide and euthanasia, which remain illegal in most states due to low voter support.
 
According to Valko, those who work in hospice or with dying patients know that pain can virtually always be controlled.  She pointed out that, “In Oregon, voters were sold their assisted suicide law by claims that terminally ill people needed lethal overdoses to relieve unbearable pain—yet even the limited data on assisted suicide victims shows that the main reasons given by the victims were fear of future suffering, losing independence, and/or being a ‘burden’ on family members.”
 
When used as euthanasia, terminal sedation is an abuse against some of the most vulnerable members of our society.  Though gentler than an abrupt removal of all medical treatment, terminal sedation as a form of slow-killing is indeed one method of euthanasia and devalues the infirm and disabled.  Additionally, families of the ailing patient are often not even informed that the reason for the terminal sedation was to cause death, and rarely was their permission sought to sedate the patient into unconsciousness.
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