January 14, 2009

  • Terminal Sedation

    This weeks ethical debate is on physician assisted suicide, currently only legal in Oregon. Sadly the majority of the articles are locked, but if you are determined, then mine was Terminal Sedation: pulling the sheet over our eyes by Margaret Battin. Timothy Quill has written a lot of articles in favor for a counterpoint.

    ...

    For all the controversey normally raised over the issue of euthanasia and physician assisted suicide, you may be surprised to learn that it is pretty much already legal in every state, under the moniker palliative (aka terminal) sedation.

    At least, that is the point made in the article terminal sedation by battin. She argues, and I agree that the distinction officially made between the two is an attempt by legislators to judge intent after the action has already been performed.

    I personally dont hold the belief that killing someone, whether directly administering an injection (such as kevorkian was notorious for) or indirectly (the "oops I accidentally left this lethal dosage of pills by your bedside a month after you mentioned you wanted to die. brb.") is appropriate in our profession.

    However that doesnt mean I dont think these same terminally ill patients should be forced to suffer. As Battin points out, In the 1997 cases Washington v. Glucksberg and Vacco v. Quill, the Supreme Court recognized the legality of providing pain relief in palliative care even if doing so might shorten life, provided the intention was to relieve pain.

    But that is where you start getting into a slippery slope. At what point does the question move from pain versus relief of pain to life versus death? In theory, autonomy is the guiding principle here, that a person should be the one to have final say over his or her health and life, including death. If pain is severe enough, reflective unimpaired consent may be impossible...a person may agree to anything to stop their own pain without fully comprehending the repercussions.

    Under Oregon law, the only state to have a physician assisted suicide law, the precautions are carefully thought out. The person must be over 18, of sound mind, with a terminal diagnosis confirmed by two separate physicians. Additionally there must be written and verbal consent, with a two week waiting period and reconsent period before the final act, as it were. So I dont dispute there are a large number of safeguards in place.

    Compared with palliative or terminal sedation, which requires no such advance consent and can be performed at any time. Terminal sedation, battin states ends pain, but it also ends life.
    It does so in two ways: it immediately ends sentient life with the coma, and by withdrawing artificial nutrition and hydration it also ends biological life. So the same end is accomplised as in physician assisted suicide as the average length of survival quoted by the ama is 1.5-3 days.

    As Battin states, "By avoiding the word “terminal” and hence the overt implication that death may be coming, the most important feature of this practice is obscured and terminal sedation is confused with “palliative care.” Thus, the patient cannot consent to the really significant decision—whether his or her life shall be ended now. Autonomy is therefore undercut whether the patient’s capacity for reflection is impaired by severe pain or not."

    Seeing the difference in protocol for both terminal sedation and oregon physician assisted suicide, I would have to say that the death with dignity acts being proposed are more in keeping with oregon ethically and place more safeguards and restrictions on the process than the ambivalent palliative sedation. However, I still object to the idea morally.

    As for the slippery slope...when do we start deciding for others how much suffering is too much and move into nonvoluntary euthasiana? The dutch already have, euthanizing babies with spina bifida

    http://www.lifesitenews.com/ldn/2008/jan/08011610.html

    Things to think on...

Comments (2)

  • Wow!  I surprisingly academic, well-thought out post.  I'm not saying that its surprising you should do it, I'm just surprised to read something so deep so early in the morning.  I have to go ahead and agree with you... if a person is in that much pain, why make them suffer just to uphold some sort of moral high-ground (which is shaky in the first place).

  • i would say america's much closer to being on the same page with the dutch than your entry seems to suggest.

    people have abortions all the time because their babies *might* have downs syndrom, spinal biffida, or other birth defects. or just because a child is inconvenient for them, therefore "saving" them from a bad home life where they're unwanted. i would say this is much the same principle as you mentioned.

    i personally think most people should stay out of the position of deciding whether other persons need to live or die. basically, i guess i'm just saying i agree with you.

    :)  

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