Justifying Different Levels of Palliative Sedation

Sulmasy, Daniel P.; Curlin, Farr A.; Brungardt, Gerard S.; Cavanaugh, Thomas A.

doi:10.7326/0003-4819-152-5-201003020-00016

Cited by 11 publications

(5 citation statements)

References 4 publications

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“…24 When considering the ethical concerns that surround sedation at the end of life, notably the principles of proportionality, preservation of patient autonomy, and the prevention of harm, 11 the potential to violate these ethical imperatives during the deliberate decrease in patient consciousness treads too closely to euthanasia for some practitioners. 14,[25][26][27][28] Although a great number of respondents agreed with the definition put forth, our findings indicate that some pediatric providers are more comfortable with symptom management that produces sedation proportional to the symptom distress, accepting unconsciousness as a foreseen but unintended side effect of symptom management.…”

Section: Discussionmentioning

confidence: 62%

Pediatrician Ambiguity in Understanding Palliative Sedation at the End of Life

Henderson

Fitzgerald

Hoehn

et al. 2016

Am J Hosp Palliat Care

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Responses point to ambiguity surrounding the concept of palliative sedation. Pediatricians were concerned with a decreased level of consciousness as the goal of palliative sedation. Respondents were split on whether they view palliative sedation as a distinct entity or as one broad continuum of care, equivalent to aggressive symptom management. Institutional-based policies are essential to clarify acceptable practice, enable open communication, and promote further research.

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Section: Discussionmentioning

confidence: 62%

Pediatrician Ambiguity in Understanding Palliative Sedation at the End of Life

Henderson

Fitzgerald

Hoehn

et al. 2016

Am J Hosp Palliat Care

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“…That is because in such cases (but not in gradual cases), doctors are believed to intend to remove consciousness. 20 This argument has often received strong support [24][25][26] ; where the argument is accepted, RTS is rejected under the DDE.…”

Section: Gradual Sedationmentioning

confidence: 99%

Expanded terminal sedation in end-of-life care

et al. 2022

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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.

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“…It is "a commitment to be a particular sort of someone." 122 The oath thus involves greater stakes than the typical promise, which is simply a commitment, generally defeasible, to do something reasonably mundane, like fulfill a contract. At worst, one might have to pay damages for non-performance and perhaps suffer harm to one's relationships or reputation.…”

Section: The Oathmentioning

confidence: 99%

The Coxford LectureHonour, Oaths, and the Rule of Law

Horwitz¹

2019

Can. J. Law Jurisprud.

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Impersonality is frequently invoked as a core element of the rule of law. In this article, I discuss a troika of values and institutions–office, honour, and the oath–that provide deeply personal springs for the conduct of judges and other office-holders. In so doing, these institutions make possible the sort of impersonality valued by the rule of law. A focus on office emphasizes the importance of duty rather than power. Honour is the desire to be well thought of by others, and the internalized desire to deserve to be thought well of by others, especially one’s peers. Honour is often treated as an obsolete value that has been superseded by dignity. But it remains an essential force, providing judges and other office-holders with a source of energy and agency that motivates them to fulfil the duties of their office with virtue and excellence. The oath serves as a linchpin that connects the individual to the office and the office-holder to the commitment to serve honourably. Taken together, this troika of institutions encourages the faithful and energetic performance of one’s judicial office in a modern democratic constitutional society. Thinking about the rule of law this way encourages us to shift our focus from power to duty, and from doctrine to character and virtue. It encourages us to revive and revise honour rather than abandon it. It helps show that an impersonal “government of laws and not men” is and ultimately must be deeply personal.

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Justifying Different Levels of Palliative Sedation

Cited by 11 publications

References 4 publications

Pediatrician Ambiguity in Understanding Palliative Sedation at the End of Life

Pediatrician Ambiguity in Understanding Palliative Sedation at the End of Life

Expanded terminal sedation in end-of-life care

The Coxford LectureHonour, Oaths, and the Rule of Law

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