Responding to Intractable Terminal Suffering
Authors: Daniel P. Sulmasy
Journal: Annals of Internal Medicine (2000)

Letters3 October 2000Responding to Intractable Terminal SufferingDaniel P. Sulmasy, OFM, MD, PhD, Wayne A. Ury, MD, Judith C. Ahronheim, MD, Mark Siegler, MD, Leon Kass, MD, PhD, John Lantos, MD, Robert A. Burt, JD, Kathleen Foley, MD, Richard Payne, MD, Carlos Gomez, MD, Thomas J. Krizek, MD, Edmund D. Pellegrino, MD, and Russell K. Portenoy, MDDaniel P. Sulmasy, OFM, MD, PhDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), Wayne A. Ury, MDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), Judith C. Ahronheim, MDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), Mark Siegler, MDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), Leon Kass, MD, PhDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), John Lantos, MDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), Robert A. Burt, JDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), Kathleen Foley, MDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), Richard Payne, MDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), Carlos Gomez, MDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), Thomas J. Krizek, MDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), Edmund D. Pellegrino, MDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy), and Russell K. Portenoy, MDSaint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-133-7-200010030-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We are deeply troubled by a recent pair of papers on terminal sedation and "voluntary refusal of food and fluids" (1, 2) and the process by which they were accepted and published in Annals. These papers appear to convey the mistaken and perhaps dangerous impression of a genuine consensus among experts and official policy endorsement of these practices. At the request of the editors, we address the issues raised by the first of these papers in this letter and address related issues separately (3, 4).It is true that terminal sedation (perhaps better called sedation in the ...References1. 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. Ann Intern Med. 2000;132:408-14. LinkGoogle Scholar2. 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. LinkGoogle Scholar3. Sulmasy DP, Ury WA, Ahronheim JC, Siegler M, Kass L, Lantos J, et al . Palliative treatment of last resort and assisted suicide [Letter]. Ann Intern Med. 2000;133:562-3. LinkGoogle Scholar4. Sulmasy DP, Ury WA, Ahronheim JC, Siegler M, Kass L, Lantos J, et al . Publication of papers on assisted suicide and terminal sedation [Letter]. Ann Intern Med. 2000;133:564-5. LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Daniel P. Sulmasy, OFM, MD, PhD; Wayne A. Ury, MD; Judith C. Ahronheim, MD; Mark Siegler, MD; Leon Kass, MD, PhD; John Lantos, MD; Robert A. Burt, JD; Kathleen Foley, MD; Richard Payne, MD; Carlos Gomez, MD; Thomas J. Krizek, MD; Edmund D. Pellegrino, MD; Russell K. Portenoy, MDAffiliations: Saint Vincents Hospital; New York, NY 10011 (Sulmasy, Ury, Ahronheim)University of Chicago; Chicago, IL 60637 (Siegler, Kass, Lantos)Yale University School of Law; New Haven, CT 06511 (Burt)Memorial Sloan-Kettering Cancer Center; New York, NY 10021 (Foley, Payne)University of Virginia; Charlottesville, VA 22908 (Gomez)University of South Florida; Tampa, FL 33620 (Krizek)Georgetown University Medical Center; Washington, DC 20007 (Pellegrino)Beth Israel Hospital; New York, NY 10003 (Portenoy) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoResponding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids Timothy E. Quill and Ira R. Byock , for the ACP-ASIM End-of-Life Care Consensus PanelPalliative Treatments of Last Resort: Choosing the Least Harmful Alternative Timothy E. Quill , Barbara Coombs Lee , and Sally Nunn , for the University of Pennsylvania Center for Bioethics Assisted Suicide Consensus PanelPalliative Treatment of Last Resort and Assisted Suicide Daniel P. Sulmasy , Wayne A. Ury , Judith C. Ahronheim , Mark Siegler , Leon Kass , John Lantos , Robert A. Burt , Kathleen Foley , Richard Payne , Carlos Gomez , Thomas J. Krizek , Edmund D. Pellegrino , and Russell K. Portenoy Publication of Papers on Assisted Suicide and Terminal Sedation Daniel P. Sulmasy , Wayne A. Ury , Judith C. Ahronheim , Mark Siegler , Leon Kass , John Lantos , Robert A. Burt , Kathleen Foley , Richard Payne , Carlos Gomez , Thomas J. Krizek , Edmund D. Pellegrino , and Russell K. Portenoy Responding to Intractable Terminal Suffering Timothy E. Quill and Ira R. Byock Palliative Treatment of Last Resort and Assisted Suicide Timothy E. Quill , Barbara Coombs Lee , and Sally Nunn Publication of Papers on Assisted Suicide and Terminal Sedation Lois Snyder Publication of Papers on Assisted Suicide and Terminal Sedation Frank Davidoff Responding to Intractable Terminal Suffering Morton Leonard Yanow Responding to Intractable Terminal Suffering Eric L. Krakauer Metrics Cited byEuthanasia and palliative sedation in BelgiumFrom Sedation to Continuous Sedation Until Death: How Has the Conceptual Basis of Sedation in End-of-Life Care Changed Over Time?Care of a Child Dying of CancerPalliative care for patients with respiratory diseases and critical illnessesAn Official American Thoracic Society Clinical Policy Statement: Palliative Care for Patients with Respiratory Diseases and Critical IllnessesPhysician 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, PhDNurses' Experiences with Hospice Patients Who Refuse Food and Fluids to Hasten DeathA clinician's understanding of ethics in palliative care:Sedation, Alimentation, Hydration, and Equivocation: Careful Conversation about Care at the End of LifeLynn A. Jansen, RN, PhD and Daniel P. Sulmasy, OFM, MD, PhDPalliative sedation vs. terminal sedation: What's in a name?Palliative Treatment of Last Resort and Assisted SuicideDaniel P. Sulmasy, OFM, MD, PhD, Wayne A. Ury, MD, Judith C. Ahronheim, MD, Mark Siegler, MD, Leon Kass, MD, PhD, John Lantos, MD, Robert A. Burt, JD, Kathleen Foley, MD, Richard Payne, MD, Carlos Gomez, MD, Thomas J. Krizek, MD, Edmund D. Pellegrino, MD, and Russell K. Portenoy, MDPublication of Papers on Assisted Suicide and Terminal SedationDaniel P. Sulmasy, OFM, MD, PhD, Wayne A. Ury, MD, Judith C. Ahronheim, MD, Mark Siegler, MD, Leon Kass, MD, PhD, John Lantos, MD, Robert A. Burt, JD, Kathleen Foley, MD, Richard Payne, MD, Carlos Gomez, MD, Thomas J. Krizek, MD, Edmund D. Pellegrino, MD, and Russell K. Portenoy, MD 3 October 2000Volume 133, Issue 7Page: 560-561KeywordsEnd of life careFoodNutritionPalliative careSedation ePublished: 3 October 2000 Issue Published: 3 October 2000 Copyright & PermissionsCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...