title: Continuous deep sedation until death: palliation or physician-assisted death?
abstract: Published literature has not discerned end-of-life palliative versus life-shortening effects of pharmacologically maintaining continuous deep sedation until death (i.e., dying in deep sleep) compared with common sedation practices relieving distress in the final conscious phase of dying. Continuous deep sedation predictably suppresses brainstem vital centers and shortens life. Continuous deep sedation remains controversial as palliation for existential suffering and in elective death requests by discontinuation of chronic ventilation or circulatory support with mechanical devices. Continuous deep sedation contravenes the double-effect principle because: (1) it induces permanent coma (intent of action) for the contingency relief of suffering and for social isolation (desired outcomes) and (2) because of its predictable and proportional life-shortening effect. Continuous deep sedation should be distinguished from common sedation practices for palliation and characterized instead as physician-assisted death.
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic Hospital, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA. Rady.Mohamed@mayo.edu
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Rady
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Verheijde
mesh_terms: D032722:Advance Care Planning / Q000941:ethics / Q000458:organization & administration; D003128:Coma / Q000139:chemically induced / Q000503:physiopathology; D054810:Deep Sedation / Q000009:adverse effects / Q000941:ethics* / Q000523:psychology; D034723:Double Effect Principle; D016903:Drug Monitoring; D005086:Existentialism / Q000523:psychology; D006297:Health Services Accessibility / Q000941:ethics / Q000458:organization & administration; D006625:Hippocratic Oath; D006801:Humans; D010166:Palliative Care / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000379:methods / Q000523:psychology; D018579:Patient Selection / Q000941:ethics; D018802:Patient-Centered Care / Q000941:ethics / Q000458:organization & administration; D028662:Principle-Based Ethics; D012934:Social Isolation / Q000523:psychology; D017236:Suicide, Assisted / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000523:psychology; D013727:Terminal Care / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000379:methods / Q000523:psychology; D014481:United States