We stand at a cultural crossroads, the intersection of the Culture of Life and the Culture of Death. At this critical juncture, the choices we make matter, now and forever. Therefore, the members of Life is Worth Living, a lay apostolate, have chosen to promote the Culture of Life.
Our mission is to strive to affirm -- in thought, word, and deed -- the infinite preciousness of human life; to encourage service to others rather than radical self-interest; and to promote a climate of public opinion that recognizes the right of all human beings to life, respect, compassionate care, appropriate medical treatment, and equality under the law.
Sedation and Dehydration- Mercy or Murder?
posted by Julie Grimstad
Thursday, May 22, 2008
Physician-assisted suicide (PAS) was legalized in Oregon in 1994. That law permits a doctor to prescribe a lethal dose of drugs at the request of a patient who is expected to die within six months. Thus far, every other state has resisted similar legislation thanks to the efforts of organizations and individuals opposed to PAS, including the Catholic Church. While the very public push to legalize assisted suicide diverted our attention, some ethicists and doctors quietly proposed a legal, but just as lethal, alternative – terminal sedation – and incorporated it into the practice of palliative medicine.
The word “palliative” describes care that comforts and relieves or moderates pain and suffering, such as the care provided by a hospice. “Terminal sedation” is a term recently added to the stock of medical phrases most people do not understand. But it is vitally important that people do understand this controversial, increasingly common method of permanently ending a person’s suffering.
“Terminal sedation” (TS) essentially means that a patient is given a sufficient amount of drugs to render and keep him unconscious until he dies, usually days or weeks later. No further active treatment is done and nutrition and hydration are often withheld. TS is also referred to as “palliative sedation” or “total sedation”. The National Hospice and Palliative Care Organization (NHPCO) presses hospice agencies to adopt TS and make it “a comfortable addition to the palliative care repertoire” (Goldstein-Shirley and Fine, “Ethics of Total Sedation”, NHPCO Ethics Committee). The claim is made that TS is aimed at relieving pain and suffering, not the intentional death of the patient. That claim is misleading. One might wonder if it is an intentional half-truth, but it is impossible to know another’s intention. Facts, on the other hand, can be examined to discern whether or not TS is, in any given case, mercy or murder.
Sedation is an important medical intervention for some patients who are near the end of life and have symptoms—pain, difficulty breathing, agitation, etc.—that have become progressively more difficult to manage and when nothing else will work. Sedation should only be used to relieve severe physical distress and never to intentionally shorten life. When used for medically and morally appropriate reasons, sedation is merciful.
However, TS is not limited to patients who are so near death that further treatment and/or food and fluids will no longer sustain their lives. Sometimes TS and withdrawal of nutrition and hydration are combined to introduce a cause of death—dehydration—unrelated to the patient’s illness. Sedation is used to keep the patient unaware as dehydration ravages his/her body. Death by sedation and dehydration can take up to two weeks or longer. For this reason, TS is sometimes called “slow euthanasia”. The Catechism of the Catholic Church defines “euthanasia” as “an act or omission which, of itself or by intention, causes death in order to eliminate suffering” and calls it a “murderous act”.
Sedation combined with dehydration is the treatment of choice for some patients who are not dying quickly enough to suit themselves or others. Regardless of who makes the decision, it is wrong. And, even though it may be legal, it is evil to deny food and water to anyone unless they will make the person’s condition worse or will no longer sustain life.
Regrettably, medical ethics and practice have largely degenerated from concern for doing what is right to merely doing what is legal. Obviously, what is legal is not always right.
The word “palliative” describes care that comforts and relieves or moderates pain and suffering, such as the care provided by a hospice. “Terminal sedation” is a term recently added to the stock of medical phrases most people do not understand. But it is vitally important that people do understand this controversial, increasingly common method of permanently ending a person’s suffering.
“Terminal sedation” (TS) essentially means that a patient is given a sufficient amount of drugs to render and keep him unconscious until he dies, usually days or weeks later. No further active treatment is done and nutrition and hydration are often withheld. TS is also referred to as “palliative sedation” or “total sedation”. The National Hospice and Palliative Care Organization (NHPCO) presses hospice agencies to adopt TS and make it “a comfortable addition to the palliative care repertoire” (Goldstein-Shirley and Fine, “Ethics of Total Sedation”, NHPCO Ethics Committee). The claim is made that TS is aimed at relieving pain and suffering, not the intentional death of the patient. That claim is misleading. One might wonder if it is an intentional half-truth, but it is impossible to know another’s intention. Facts, on the other hand, can be examined to discern whether or not TS is, in any given case, mercy or murder.
Sedation is an important medical intervention for some patients who are near the end of life and have symptoms—pain, difficulty breathing, agitation, etc.—that have become progressively more difficult to manage and when nothing else will work. Sedation should only be used to relieve severe physical distress and never to intentionally shorten life. When used for medically and morally appropriate reasons, sedation is merciful.
However, TS is not limited to patients who are so near death that further treatment and/or food and fluids will no longer sustain their lives. Sometimes TS and withdrawal of nutrition and hydration are combined to introduce a cause of death—dehydration—unrelated to the patient’s illness. Sedation is used to keep the patient unaware as dehydration ravages his/her body. Death by sedation and dehydration can take up to two weeks or longer. For this reason, TS is sometimes called “slow euthanasia”. The Catechism of the Catholic Church defines “euthanasia” as “an act or omission which, of itself or by intention, causes death in order to eliminate suffering” and calls it a “murderous act”.
Sedation combined with dehydration is the treatment of choice for some patients who are not dying quickly enough to suit themselves or others. Regardless of who makes the decision, it is wrong. And, even though it may be legal, it is evil to deny food and water to anyone unless they will make the person’s condition worse or will no longer sustain life.
Regrettably, medical ethics and practice have largely degenerated from concern for doing what is right to merely doing what is legal. Obviously, what is legal is not always right.
Labels: Euthanasia, Hospice/Palliative Care