Careful Conversation about Care at the End of Life
Authors: Paul Rousseau
Journal: Annals of Internal Medicine (2002)

Letters17 December 2002Careful Conversation about Care at the End of LifePaul Rousseau, MDPaul Rousseau, MDVeterans Affairs Medical Center; Phoenix, AZ 85012Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-12-200212170-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:When discussing terminal sedation (more palatably referred to as palliative sedation), Jansen and Sulmasy (1) state that the rule of double effect is morally acceptable if “one does not aim at unconsciousness directly” and “unconsciousness is not the means by which one intends to relieve symptoms.” I contest this interpretation, since unconsciousness is certainly the means to relieve suffering in refractory situations. Consequently, I am perplexed by the authors' assertions about the moral and therapeutic actions of sedation. If they believe that suffering is not directly relieved by sedation, why sedate?Jansen and Sulmasy then state that ...Reference1. Jansen LA, Sulmasy DP. Sedation, alimentation, hydration, and equivocation: careful conversation about care at the end of life. Ann Intern Med. 2002;136:845-9. [PMID: 12044133] LinkGoogle Scholar2. Rousseau PC. Existential suffering and palliative sedation: a brief commentary with a proposal for clinical guidelines. Am J Hosp Palliat Care. 2001;18:151-3. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Paul Rousseau, MDAffiliations: Veterans Affairs Medical Center; Phoenix, AZ 85012Disclaimer: The opinions expressed in this letter are those of the author and do not necessarily represent the opinions of the Department of Veterans Affairs. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSedation, Alimentation, Hydration, and Equivocation: Careful Conversation about Care at the End of Life Lynn A. Jansen and Daniel P. Sulmasy Careful Conversation about Care at the End of Life Lynn A. Jansen and Daniel P. Sulmasy Physician Involvement in Voluntary Stopping of Eating and Drinking Bernard Gert , James L. Bernat , and R. Peter Mogielnicki Physician Involvement in Voluntary Stopping of Eating and Drinking Lynn A. Jansen and Daniel P. Sulmasy Careful Conversation about Care at the End of Life Charles G. Sasser Careful Conversation about Care at the End of Life Timothy E. Quill Careful Conversation about Care at the End of Life Tatsuya Morita , Satoru Tsuneto , and Yasuo Shima Careful Conversation about Care at the End of Life John H. Kvasnicka Metrics Cited byPalliative sedation, foregoing life-sustaining treatment, and aid-in-dying: what is the difference?Continuous sedation until death: moral justifications of physicians and nurses—a content analysis of opinion piecesThe Moral Difference or Equivalence Between Continuous Sedation Until Death and Physician-Assisted Death: Word Games or War Games?Palliative sedation until death: an approach from Kant’s ethics of virtueSedation for the care of patients with advanced cancerEthical Validity of Palliative Sedation Therapy: A Multicenter, Prospective, Observational Study Conducted on Specialized Palliative Care Units in JapanPhysician Reports of Terminal Sedation without Hydration or Nutrition for Patients Nearing Death in the NetherlandsJudith A.C. Rietjens, MSc, Agnes van der Heide, MD, PhD, Astrid M. Vrakking, MSc, Bregje D. Onwuteaka-Philipsen, PhD, Paul J. van der Maas, MD, PhD, and Gerrit van der Wal, MD, PhD 17 December 2002Volume 137, Issue 12Page: 1009-1010KeywordsConsciousnessDo not resuscitate ordersDrug therapyEnd of life careEuthanasiaForecastingPainReasoningSedationSedatives ePublished: 17 December 2002 Issue Published: 17 December 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...