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Yes, definitely. Technically, terminal sedation is using aggressive medical
means to help the patient escape from the suffering by being sedated, and often
withdrawing any life-sustaining devises such as a ventilator or intravenous
feeding. Many people believe it to be ethically preferable to physician-assisted
suicide.
It's interesting, however, that there is another distinction between physician-assisted
suicide and terminal sedation, which cuts opposite the usual analysis. If you
ask by whose hand is the patient being assisted, in terminal sedation, it is
the healthcare team who's in charge. Whereas in physician-assisted suicide,
you arguably could say it is the patient who ultimately must take or not take
the medication. So there is that safeguard in physician-assisted suicide that
is not provided in terminal sedation.
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From
my perspective, terminal sedation represents the continuum of palliative care,
and when it is needed, it is incumbent on us as clinicians to be able to provide
that full continuum. Otherwise, patients will be left to suffer unnecessarily,
and frankly often, to die in physical agony. In such circumstances, it is not
only acceptable, it is probably requisite that we offer it and, unless patients
refuse it, sedation ought to be made readily available.
We as a society have given physicians certain powers that other members of
society don't have. There must be certain constraints on physicians authority
to to write prescriptions and to minister to patients. We are not to prescribe
lethal injections or lethal medications to patients, even when patients may
request assisted suicide-- seeing it as preferable to terminal sedation.
The meaning of those actions and what they represent in terms of our social
responsibility to the patient are very different. Even when faced with a suffering
patient who is making repeated requests to end his or her life, there are some
things as a doctor that I simply cannot do.
I worry that when we accede to the requests of patients to give them a lethal
prescription, the suffering that we're alleviating is our own. In terminal sedation,
that's not the case. It remains a round-the-clock, emotionally and physically
exhausting exercise for physicians, medical workers and caregivers.
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