Expanded terminal sedation in end-of-life care

Bibliographic Data

ID21514014
AuthorsLaura Gilbertson (0009-0006-5962-4864, University of Oxford), Julian Savulescu (0000-0003-1691-6403, National University of Singapore, corresponding author), Justin Oakley (0000-0003-3609-0020, Monash University), Dominic Wilkinson (0000-0003-3958-8633, National University of Singapore)
Year2023
Volume49
Issue4
Pages252-260
Publication date2023-04-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueJournal of Medical Ethics (JOURNAL)
Journal identifiersISSN: 0306-6800 • E-ISSN: 1473-4257
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/jme-2022-108511
PMID36543531
OpenAlexW4312061423
LanguageEN
Citations received11
References cited40

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

End-of-life care · Intensive care medicine · Palliative care · Palliative sedation · Psychiatry · Sedation · Unconsciousness · Ethics in medical practice · Medicine · Nursing · Palliative Care and End-of-Life Issues · Patient Dignity and Privacy · Surgery

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