Although legal, the authors contend that the latter two options are themselves ethically and clinically more complex and closer to PAS and VAE than is ordinarily acknowledged. The process usually takes one to three weeks or longer. The main disadvantages of VSED are that it may last for weeks and may initially increase suffering. Terminal Sedation With TS, the suffering patient is sedated to unconsciousness, usually through ongoing administration of barbiturates or benzodiazepines. The patient then dies of dehydration, starvation or some other complication, as all life-sustaining interventions are withheld.
Death usually takes days to weeks.
TS is already openly practiced by some palliative care and hospice groups in cases of unrelieved suffering and has wide legal and ethical acceptance because the sedation is intended to relieve suffering, a long-standing and uncontroversial aim of medicine. The authors also point out that there may still be confusion about the physician's ethical responsibility for contributing to the patient's death. Although the physician is morally responsible for this assistance, the patient has to carry out the final act. The authors note that PAS is illegal in most states, however, no physicians have ever been successfully prosecuted for their participation. Physician-assisted suicide is usually conducted covertly, without consultation, guidelines or documentation.