4 March 2013
Is Early Terminal Sedation Humane or Cold-Blooded
Socrates, is accredited with having said, "Young men fear death; old men fear dying." Young men fear the loss of all they might have accomplished or what might have been. They may fear not having had time to make a name for themselves that would leave their foot print of existence ‘immortal’. Old men, having experienced what life had to offer them, fear the process of dying itself. They fear that their death may be dragged out in some despicable manner. In the modern age, where control and effectiveness are of the greatest virtues, people fear dying alone, in pain and being a burden on others. They fear the kind of dying process that modern medicine is capable of inducing. “Frank Foster, 60, sleeping under sedation to relieve pain and other effects of liver cancer, in the hospice unit at Franklin Hospital in Valley Stream on Long Island. Terminally ill patients, their families and their medical teams have the option of choosing palliative sedation to make dying less painful and to ease other effects of the transition, like shortness of breath, delirium or anxiety”
In this combative discussion over whether people have a right to die, the most ardent opponents on both sides can agree on one fact; the terminally ill must be made as tranquil and comfortable as possible. But now a provocative procedure is questioning that consensus.
“With modern medicine chemically induced sedation is a clinically important therapeutic intervention in the imminently dying patient. As the patient with irreversible illness nears the end of their life, symptoms accumulate (and)…may become unresponsive to standard medical interventions. The most common of these intractable symptoms are pain and psychological distress. Though sedation is a risk-laden method, it is sometimes essential and preserves the physician's two obligations to benefit patients and to "do no harm". 1
Before considering the ethical issues associated with early terminal sedation let use some imagery about a hypothetical situation. “An eighty-year old woman is taken to the hospital for severe stomach pain. She has a history of cancer; several years ago, doctors were forced to excise a portion of her intestine. Now, a medical scan shows that the cancer has come back. Her doctors expect that she will survive only a few weeks. They start her on high doses of narcotics to control her pain. Her physicians recommend a catheter to deliver the narcotics; the woman is horrified by the thought of a tube protruding out of his spine. Her doctors tell her and her family that sedation will almost certainly shorten her life to a few days, but she doesn't care and the family agrees. She doesn't see why she should have to go through ‘hell’ just to live a few more horrible days or weeks. Now, what do we do? Where do go from here. These are serious questions that ethicists face.
Terminal sedation has been criticized by those surveyed to be grammatically ambiguous and confusing; it can be construed as meaning either one of two things: sedation intended for terminally ill patients or sedation for the purpose of terminating a patient's life.2 Some argue that sedating a patient in intolerable, terminal pain is appropriate. Others argue that doing so is equivalent to killing the person. We now have a debate that will offer a thought provoking discussion. The ethical discussion about this practice centers on the degree to which it should be considered an end-of-life decision that possibly or certainly hastens death.
The deliberations over sanctioning physician assisted suicide and euthanasia have grown more passionate in recent years. They have been fueled by an aging populace and a growing health care cost. As with assisted suicide and euthanasia, ‘early terminal sedation’ or (ETS) has become a very controversial practice. The ‘early terminal sedation’ is the use of large doses of sedatives to relieve extremes of