Terminal Sedation: An Acceptable Exit Strategy?
Authors: Muriel R. Gillick
Journal: Annals of Internal Medicine (2004)

Editorials3 August 2004Terminal Sedation: An Acceptable Exit Strategy?Muriel R. Gillick, MDMuriel R. Gillick, MDFrom Harvard Vanguard Medical Associates, Harvard Medical School, Boston, MA 02215.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-3-200408030-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Dying well" (1) remains an elusive goal in America (2). Only gradually is comprehensive palliative care gaining acceptance as the standard of care for alleviating suffering and promoting patient autonomy near the end of life (3). In addition to symptom management, advance care planning, and psychosocial support, such care may encompass a variety of ethically charged practices, one of which, terminal sedation, is the subject of the report by Rietjens and colleagues in this issue (4).At one end of the ethical spectrum, end-of-life care includes withdrawal or withholding of life-sustaining treatment, which is now legally and ethically accepted in ...References1. Byock I. Dying Well: Peace and Possibilities at the End of Life. New York: Riverhead Books; 1998. Google Scholar2. Means to a Better End: A Report on Dying in America Today. November 2002. Accessed at www.lastacts.org/files/misc/meansfull.pdf on 18 March 2004. Google Scholar3. Butler RN, Burt R, Foley KM, Morris J, Morrison RS. Palliative medicine: providing care when cure is not possible. A roundtable discussion: Part I. Geriatrics. 1996;51:33-6, 42-4. [PMID: 8621101] MedlineGoogle Scholar4. Rietjens JA, van der Heide A, Vrakking AM, Onwuteaka-Philipsen BD, van der Maas PJ, van der Wal G. Physician reports of terminal sedation without hydration or nutrition for patients nearing death in the Netherlands. Ann Intern Med. 2004;141:178-85. LinkGoogle Scholar5. Faber-Langendoen K. A multi-institutional study of care given to patients dying in hospitals. Ethical and practice implications. Arch Intern Med. 1996;156:2130-6. [PMID: 8862106] CrossrefMedlineGoogle Scholar6. Burt RA. The Supreme Court speaks—not assisted suicide but a constitutional right to palliative care. N Engl J Med. 1997;337:1234-6. [PMID: 9337388] CrossrefMedlineGoogle Scholar7. Quill TE, Lo B, Brock DW. Palliative options of last resort: a comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia. JAMA. 1997;278:2099-104. [PMID: 9403426] CrossrefMedlineGoogle Scholar8. Loewy EH. Terminal sedation, self-starvation, and orchestrating the end of life. Arch Intern Med. 2001;161:329-32. [PMID: 11176757] CrossrefMedlineGoogle Scholar9. Yanow ML. Responding to intractable terminal suffering [Letter]. Ann Intern Med. 2000;133:560. [PMID: 11015173] LinkGoogle Scholar10. Chater S, Viola R, Paterson J, Jarvis V. Sedation for intractable distress in the dying—a survey of experts. Palliat Med. 1998;12:255-69. [PMID: 9743824] CrossrefMedlineGoogle Scholar11. Orentlicher D. The Supreme Court and physician-assisted suicide—rejecting assisted suicide but embracing euthanasia. N Engl J Med. 1997;337:1236-9. [PMID: 9340517] CrossrefMedlineGoogle Scholar12. Washington v. Glucksberg. 117 SCt 2258 (1997). Google Scholar13. 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 Scholar14. Sulmasy DP, Pellegrino ED. The rule of double effect: clearing up the double talk. Arch Intern Med. 1999;159:545-50. [PMID: 10090110] CrossrefMedlineGoogle Scholar15. Billings JA, Block SD. Slow euthanasia. J Palliat Care. 1996;12:21-30. [PMID: 9019033] CrossrefMedlineGoogle Scholar16. Quill TE, Lee BC, Nunn S. Palliative treatments of last resort: choosing the least harmful alternative. University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel. Ann Intern Med. 2000;132:488-93. [PMID: 10733450] LinkGoogle Scholar17. Max M, Cleary J, Ferrell B, Foley K, Payne R, Shapir B. Treatment of pain at the end of life: a position statement from the American Pain Society. Accessed at www.ampainsoc.org/advocacy/treatment.htm on 15 June 2004. Google Scholar18. Clinical Practice Guideline for Palliative Sedation. Calgary Regional Health Authority. Spring 1999. Accessed at www.crha-health.ab.ca/clin/cme/cpg/palliativesedation1999.pdf on 18 March 2004. Google Scholar19. Quill TE, Byock IR. Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of food and fluids. ACP–ASIM End-of-Life Care Consensus Panel. American College of Physicians–American Society of Internal Medicine. Ann Intern Med. 2000;132:408-14. [PMID: 10691593] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Harvard Vanguard Medical Associates, Harvard Medical School, Boston, MA 02215.Disclosures: None disclosed.Corresponding Author: Muriel R. Gillick, MD, Department of Ambulatory Care, Harvard Pilgrim/Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02215. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPhysician Reports of Terminal Sedation without Hydration or Nutrition for Patients Nearing Death in the Netherlands Judith A.C. Rietjens , Agnes van der Heide , Astrid M. Vrakking , Bregje D. Onwuteaka-Philipsen , Paul J. van der Maas , and Gerrit van der Wal Terminal Sedation in the Netherlands Zbigniew Zylicz Metrics Cited byReasons for continuous sedation until death in cancer patients: a qualitative interview studyTrends in Continuous Deep Sedation until Death between 2007 and 2013: A Repeated Nationwide SurveyEnd of Life ChoicesIntentional Sedation to Unconsciousness at the End of Life: Findings From a National Physician SurveyJustifying continuous sedation until death: A focus group study in nursing homes in Flanders, BelgiumEthical issues in states of impaired communication with intact consciousness and languageThe Moral Difference or Equivalence Between Continuous Sedation Until Death and Physician-Assisted Death: Word Games or War Games?Vulnerability and the 'slippery slope' at the end-of-life: a qualitative study of euthanasia, general practice and home death in The NetherlandsDeciding about continuous deep sedation: physicians' perspectivesWhen cancer symptoms cannot be controlled: the role of palliative sedationContinue diepe sedatie bij patiënten in de laatste levensfaseTo Die, to Sleep: US Physicians' Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life SupportEthical issues in the management of patients with impaired consciousnessThe Ethics of Palliative Sedation as a Therapy of Last ResortQuels sont les aspects éthiques des décisions de suppléance et de leur réversibilité ?Terminal Sedation in the NetherlandsZbigniew Zylicz, MD, PhDZur Unterscheidung von terminaler Sedierung und Sterbehilfe 3 August 2004Volume 141, Issue 3Page: 236-237KeywordsBehaviorComaEuthanasiaNutritionPalliative carePatient advocacyReasoningResearch designSedationSuicide ePublished: 3 August 2004 Issue Published: 3 August 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...