Terminal sedation (also known as palliative sedation, slow euthanasia or sedation for intractable distress in the dying/of a dying patiënt) 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 or subcutaneous infusion of morphine or other opioid drugs and benzodiazepines. In practice (though not by definition) this implies that the patient is not receiving any nutrition or other life-sustaining therapy while sedated. An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... The subcutis is the layer of tissue directly underlying the cutis. ... Morphine (INN), the principal active agent in opium, is a powerful opioid analgesic drug. ... An opioid is any agent that binds to opioid receptors found principally in the central nervous system and gastrointestinal tract. ... The benzodiazepines are a class of drugs with hypnotic, anxiolytic, anticonvulsant, amnestic and muscle relaxant properties. ... Life support, in the medical field, refers to a set of therapies for preserving a patients life when essential body systems are not functioning sufficiently to sustain life unaided. ...

There is no evidence that titrated sedation causes the death of the patient and sedation does not equate with euthanasia. At the end of life sedation is only used if the patient perceives their distress to be unbearable, and there are no other means of relieving that distress. In palliative care the doses of sedatives or opioids are titrated to keep the patient comfortable without compromising respiration. There is extensive experience and several studies to show that opioid drugs such as morphine 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 naturally from the pre-existing disease process. Euthanasia (Greek: ευθανασία - ευ good, θανατος death) refers to assisted dying. ... Palliative care is any form of medical care or treatment that concentrates on reducing the severity of the symptoms of a disease or slows its progress rather than providing a cure. ...

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 and the clinical team need to act in the patient's best interests. As sedation and opioids are titrated to avoid harm (including death), there is no legal or ethical uncertainty in a treatment which is purely for comfort. Consequently, 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. A living will, ˌliving ˈwill [countable] is a document explaining what medical or legal decisions someone should make if you become so ill that you cannot make those decisions yourself. ... Suicide (from Latin sui caedere, to kill oneself) is the act of willfully ending ones own life; it is sometimes a noun for one who has committed or attempted the act. ...

Sedation at the end of life should be a treatment response to the symptom distress of terminal restlesness and agitation. There is a problem for the nurse or doctor in deciding who is distressed; the patient themself, the family or the professional. However, the routine sedation of patients at the end of life should not be considered appropriate. Opiates are not sedatives but are analgesics. Their effectiveness in managing agitation is doubtful. They may, however relieve respiratory distress, and may be euphoric. In these ways restlessness may be reduced. I believe it to be unacceptable to use the term "slow euthanasia" in this context.

See also

• Uniform Rights of the Terminally Ill Act
• Doctrine of double effect

The Uniform Rights of the Terminally Ill Act (1985, revised 1989), has been recommended as a Uniform Act in the United States, and subsequently been passed by many states. ... The doctrine of double effect (DDE) is a thesis in ethics, usually attributed to Aquinas. ...

External links

• End of Life Choices
• American College of Physicians & American Society of Internal Medicine consensus statement on terminal sedation
• World Federation of Right to Die Societies - statement on terminal sedation