title: Sedation, alimentation, hydration, and equivocation: careful conversation about care at the end of life.
abstract: In the recent medical ethics literature, several authors have recommended terminal sedation and refusal of hydration and nutrition as important, morally acceptable, and relatively uncontroversial treatment options for end-of-life suffering. However, not all authors use these terms to refer to the same practices. This paper examines the various ways that the terms terminal sedation and refusal of hydration and nutrition have been used in the medical literature. Although some of these practices are ethically appropriate responses to end-of-life suffering, others (at least as they are currently described in the medical ethics literature) are not. This paper identifies and discusses the principles that morally distinguish these practices from one another and specifically describes different features of medical practices and moral principles that affect the moral acceptability of various medical treatments. These distinctions reveal the complexity of the issues surrounding terminal sedation and refusal of hydration and nutrition, a complexity that has not been adequately addressed in recent discussions.
authors.affiliation: The John J. Conley Department of Ethics, Saint Vincent's Hospital and Medical Center, 153 West 11th Street (NR 815), New York, NY 10011, USA. ljansen@saintvincentsnyc.org
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Jansen
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Sulmasy
mesh_terms: D000328:Adult; D034723:Double Effect Principle; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000523:psychology; D009626:Terminology as Topic; D016312:Treatment Refusal
chemical_list: D006993:Hypnotics and Sedatives