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. 2023 Apr;49(4):252-260.
doi: 10.1136/jme-2022-108511. Epub 2022 Dec 21.

Expanded terminal sedation in end-of-life care

Laura Gilbertson  1   2 , Julian Savulescu  3   4   5 , Justin Oakley  6 , Dominic Wilkinson  2   4   5   7
Affiliations

Expanded terminal sedation in end-of-life care

Laura Gilbertson et al. J Med Ethics. 2023 Apr.

Abstract

Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term 'Expanded TS' (ETS) can be used to describe the use of sedation at the end of life outside one or more of these limits.In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We argue that ETS is morally permissible: (1) in cases of non-refractory suffering where earlier treatments are likely to fail, (2) where gradual sedation is likely to be ineffective or where unconsciousness is a clinically desirable outcome, (3) where the patient meets all criteria for assisted dying or (4) where the patient has greater than 2 weeks to live, is suffering intolerably, and sedation is considered to be the next best treatment option for their suffering.While remaining two distinct practices, there is scope for some convergence between the criteria for assisted dying and the criteria for ETS. Dying patients who are currently ineligible for TS, or even assisted dying, should not be left to suffer. ETS provides one means to bridge this gap.

Keywords: Euthanasia; Pain Management; Palliative Care; Right to Die; Terminal Care.

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Conflict of interest statement

Competing interests: JS is a Bioethics Committee consultant for Bayer Pharmaceutical. There are no other COI.

Figures

Figure 1
Figure 1
Quality of consciousness at the end of life.
Figure 2
Figure 2
Convergence between the eligibility criteria for VAD, ETS and TS in Victoria. ETS, expanded terminal sedation; TS, terminal sedation; VAD, voluntary assisted dying.
See this image and copyright information in PMC

Comment in

References

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