For it to apply categorically to palliative sedation
, an ethically defensible justification must be constructed for imposing proportionality on patients who do not value such nuance, who are not likely to be harmed by total and immediate symptom control, and who would be harmed without it.
Meisel, "Last-Resort Options for Palliative Sedation," Annals of Internal Medicine 151 (2009): 421-24.
de Graeff, "A National Guideline for Palliative Sedation in the Netherlands," Journal of Pain and Symptom Management 34 (2007): 666-70; National Ethics Committee, Veterans Health Administration, "The Ethics of Palliative Sedation as a Therapy of Last Resort," American Journal of Hospice and Palliative Care 23 (2006): 483-91; B.
Palliative sedation to unconsciousness requires informed consent, either from the patient or the patient's surrogate, he added.
in Sacramento, asked whether it's acceptable for the medical team to bring up the issue of palliative sedation to unconsciousness if the patient or the patient's surrogate has not already done so.
This is certainly less controversial and in our understanding a more appropriate use of palliative sedation.
We think one can use palliative sedation while opposing physician-assisted death, depending on how sedation is practiced.
In releasing its position statement and commentary on the "Use of Palliative Sedation in Imminently Dying Terminally Ill Patients," NHPCO seeks to:
clarify the position of NHPCO on the use of palliative sedation for patients at the end of life,
It may also be perceived as less final than physician-assisted death: some forms of palliative sedation involve lightening up on the level of sedation periodically--for example, once a day--to see if the patient is still suffering.
And it distinguishes between physical and existential suffering, insisting that palliative sedation may be appropriate in the former but that measures like social supports are to be used for the latter.
The bill as introduced would have put doctors in a bind to either comply with the desire of a patient to receive palliative sedation
ending in death at an early and medically inappropriate time, or transfer them to a physician who would.