Moral concerns with sedation at the end of life

Résumé

Comments on articles by Judith AC Rietjens textitet al. and Kasper Raus textitet al. These two studies add to the growing body of qualitative evidence relating to the use of sedatives at the end of life. The respondents in the paper by Reitjens et al were reported to believe that sedation does not hasten death. There is little evidence that sedation significantly hastens death when doses are carefully titrated against symptoms-giving only that amount of a drug necessary to make the patient feel less distressed, and preserving consciousness as far as possible. Probably most sedative use in palliative care practice fits into the first category, which might be called proportional sedation. The second category which is the explicit focus of the paper by Raus et al, is continuous sedation to unconsciousness, with the aim that the patient remains unconscious until they die. If the sedation starts early enough in the course of the patient's illness, and if nutrition and hydration are withheld, death is clearly going to be hastened. The third category is a form of euthanasia, where the aim is to hasten the patient's death using sedative drugs. A theme emphasized in both these studies is that heavy sedation is a practice largely limited to the very late stages of illness when it is at least doubtful that there is much life-shortening effect. FIN-DE-VIE SOIN-PALLIATIF EUTHANASIE ÉTHIQUE