Is Palliative Sedation a Form of Euthanasia?

Palliative sedation is medication used to ease pain for terminally ill patients. Death may follow the administration of these drugs, but the medications are not given with the intent to end life.

This makes palliative sedation different from euthanasia or physician-assisted suicide. In euthanasia or physician-assisted suicide, the drugs are given for the express purpose of ending the person's life.

This article discusses palliative sedation and how it differs from euthanasia and physician-assisted suicide.

When Is Palliative Sedation Used?

Palliative sedation is used to relieve refractory symptoms. Refractory symptoms are symptoms that can't be controlled with standard therapies and are unlikely to respond to more extreme additional treatments without causing intolerable side effects. Examples of refractory symptoms include:

•  Pain
•  Shortness of breath
•  Agitation
•  Delirium

Palliative sedation is often used in people with cancer who are in the final stages of the disease, but it may also be used to relieve refractory symptoms in people with other advanced terminal illnesses such as:

• Amyotrophic lateral sclerosis (ALS)
• Advanced lung disease
• Dementia
• Heart failure

Palliative sedation always requires the consent of the patient, or their healthcare decision-maker if the patient can no longer make their own decisions. The medication is usually given by an infusion or suppository and often causes prompt sedation. Therefore, the sick person can not administer their own sedation; it can only be given by a physician, nurse, or the patient's primary caregiver.

Palliative sedation may be tried for a short time with the goal of letting the sedation wear off so as to assess the patient's comfort, or it may be used to maintain a desired level of sedation until death. Either the patient or their healthcare decision-maker makes the decision as to how heavily and how long the patient should be sedated.

Death may occur some time 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.

Ethical Considerations

Palliative sedation is controversial because of the ethical questions it raises. For example, a person who is experiencing refractory symptoms may not be competent enough to give informed consent to a procedure that might ultimately lead to their death.

Some healthcare providers argue that because palliative sedation can prematurely end someone's life, it conflicts with the nonmaleficence principle, which is to avoid causing harm. Others say it may be used as an alternative to expensive treatments or as a way for caregivers to end their responsibility to the sick person.

Palliative Sedation vs. 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, consider Dr. Jack Kevorkian who was a strong supporter and participator in physician-assisted death long before any state legalized the act. He gave a lethal dose of medication to Thomas Youk after he became unable to administer the drug to himself; this was an act of voluntary euthanasia and landed Dr. Kevorkian in prison.

Voluntary euthanasia is not legal in most parts of the world. Only five countries currently allow this practice (The Netherlands, Belgium, Luxembourg, Canada, and Colombia). Involuntary euthanasia is not legal anywhere.

Palliative Sedation vs. Physician-Assisted Suicide

Physician-assisted suicide (PAS), also referred to as physician-assisted dying (PAD) or medical aid in dying (MAiD), is the act of a physician writing a prescription for a lethal dose of medication that the patient takes on their own accord in order to cause death.

PAS is currently legal in the United States in 10 states and the District of Columbia, 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. The most fundamental aspect of PAS is that the lethal dose is self-administered. It is not legal for a physician, friend, family member, or anyone else to give the medication as that would be, by definition, euthanasia.

Summary

Palliative sedation is sedation given to a terminally ill person to relieve symptoms such as severe pain and shortness of breath. Although death can sometimes occur after the person receives sedation, it is not done with the purpose of causing death. This is what differentiates palliative sedation from euthanasia or physician-assisted suicide.

Palliative sedation is only given with the consent of the patient or the patient's legal representative. The person who receives it must be terminally ill, and healthcare providers should have tried other ways to relieve the person's symptoms before using palliative sedation.