Terminal sedation is the practice of inducing unconsciousness in a terminally ill person for the remainder of the person's life, usually by means of a continuous intravenous infusion of morphine or other opioid drugs. In practice (though not by definition) this implies that the patient is not receiving any nutrition or other life-sustaining therapy while sedated.
There is controversy as to whether terminal sedation should be considered a form of euthanasia, or only a form of palliative care. Sedating the patient does not directly hasten death; opioid drugs are not fatal as long as the dose is adjusted to keep the patient's respiratory rate from dropping too low—as continuous sedation orders require—and sedation by itself can actually prolong life to some degree, by relieving respiratory distress and strain on the heart. Death results from dehydration and/or from the pre-existing disease process, just as if the patient had refused food, water, and treatment while remaining awake.
Patients (or their legal representatives) do have the right to refuse life-sustaining treatment (such as with a living will), which is legally considered neither euthanasia nor suicide. However, once unconsciousness begins, the patient is no longer able to decide to stop the sedation or to request food or water; this is what puts terminal sedation in a legal and ethical gray area, and causes some to refer to it as slow euthanasia.
Despite the ongoing controversy, terminal sedation is generally considered legal and acceptable, as belonging to normal medical practice, even in jurisdictions where euthanasia and physician-assisted suicide are not.
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Last updated: 05-18-2005 00:06:27
