[Terminal sedation in mentally competent patients: no overriding medical-ethical arguments against in the medical literature]

Abstract

Objective: To collect medical-ethical arguments for and against the practice of terminal sedation in mentally-competent patients.

Design: Literature search.

Method: Medical-ethical arguments for and against the practice of terminal sedation were sought in electronic databases, for example Pubmed, Medline, and the Netherlands Institute for Scientific Information Services. The arguments found can help in making a well-considered and careful decision.

Results: Terminal sedation can be defined as deliberately inducing and maintaining deep sleep in terminally-ill patients with recalcitrant symptoms, by using high doses of sedatives but without the intention of hastening death. Arguments in favour of this approach included: good care provision, useful medical procedure, autonomy of the patient, the doctrine of the double effect and an alternative for euthanasia and assisted suicide. Arguments against included: impossible to communicate due to sedation, responsibility for unintended consequences, shortening the length of life, religious and cultural objections, incompetence, abuse by the care-provider or the patient and the interest of the physician.

Conclusion: In the literature no overriding moral objections to the use of terminal sedation were found. This palliative option may be regarded as a useful addition to the existing range of interventions. Although it can never be excluded, abuse is not a decisive factor. There seems to be a need for a guideline with meticulous criteria and procedures that promotes the responsible use of this intervention.