Does Palliative Sedation Cause Death?

Question: Does Palliative Sedation Cause Death?

Palliative sedation, sometimes referred to as terminal sedation, is the progressive use of sedatives to achieve a desired level of comfort and sedation in terminally ill patients experiencing unrelieved suffering. Death usually follows shortly after a patient becomes sedated, making some people wonder if palliative sedation isn't just another form of euthanasia or physician-assisted suicide.

Answer: Palliative sedation is not euthanasia nor is it physician-assisted suicide. Fundamental differences in each one of these things make them distinctly separate. Let's review each one and how they differ from each other.

Euthanasia

Euthanasia is defined as the act of a third party, usually a physician, ending a patient's life in response to severe pain or suffering. Euthanasia can be voluntary -- meaning the physician has obtained the patient's informed consent -- or involuntary, without the knowledge or consent of the patient. For example, when an animal is euthanized, it is done so involuntarily because the animal cannot give consent. In contrast, when Dr. Jack Kevorkian, who was a strong supporter and participator in physician-assisted suicide long before any state legalized the act, gave a lethal dose of medication to Thomas Youk after Youk became unable to administer the drug to himself, it was an act of voluntary euthanasia and landed Dr. Kevorkian in prison.

Voluntary euthanasia is not legal in most parts of the world. The Netherlands and Belgium are currently the only countries who allow the practice. Involuntary euthanasia is not legal anywhere.

Physician-Assisted Suicide

Physician-assisted suicide (PAS) is the act of a physician writing a prescription for a lethal dose of medication that the patient takes himself to cause death. The fundamental difference here is that the patient must take the medication himself.

PAS is currently legal in the United States in the states of Oregon and Washington, and in a handful of other countries. It is done only when a patient has a terminal diagnosis, is suffering, and wants to control when and how they die. An important piece of PAS is that the patient must take the medication himself. It is not legal for a physician, friend, family member, or anyone else to give the medication because that would be, by definition, euthanasia.

Palliative Sedation

In contrast to euthanasia and physician-assisted suicide, the intent of palliative sedation is not to cause death, but to relieve suffering. Palliative sedation is only given to relieve severe, unrelieved suffering and only when a patient is already close to death.

Palliative sedation may be tried for short time with the goal to let the sedation wear off and assess the patients comfort or it may be decided to maintain a desired level of sedation until death. The patient or his healthcare decision maker participate in making the decision how heavily and how long the patient should be sedated.

Death may occur sometime after inducing sedation but it's often unclear if the terminal illness or the sedative medication actually caused it. Because causing or hastening death isn't the intent of palliative sedation, it cannot be equated with either euthanasia or PAS.

Palliative sedation always requires the consent of the patient or his healthcare decision maker if he can no longer make decisions himself. The medication is usually given by an infusion or suppository and often causes prompt sedation, making it impossible for the patient to give the correct dose himself. Therefore, the sedatives can be given by a physician, nurse, or the patient's primary caregiver.

_Sources:

Chronology of Dr. Jack Kevorkian's Life and Assisted Suicide Campaign. Frontline. WGBH. http://www.pbs.org/wgbh/pages/frontline/kevorkian/chronology.html Retrieved on 2009-06-22.

Bernard Lo, MD; Gordon Rubenfeld, MD, MSc. Palliative Sedation in Dying Patients. JAMA. 2005;294:1810-1816.