Sedation for the imminently dying: survey results from the AAN Ethics Section.
OBJECTIVE
Sedation for the imminently dying (SFTID) is a controversial practice that involves the provision of sedation to imminently dying patients with the intent of relieving their suffering when symptoms are refractory to other interventions. The goal of this research was to ascertain the opinions regarding SFTID that are held by neurologists who are interested in ethics and end-of-life care.


METHODS
Members of the American Academy of Neurology Ethics Section were surveyed regarding their familiarity and experience with SFTID and their opinions pertaining to it. To determine whether their opinions varied in relationship to clinical context, a single stem question for 5 different case scenarios was used.


RESULTS
A total of 96% of respondents agreed or strongly agreed that the primary purpose of SFTID was to relieve suffering, 83% disagreed or strongly disagreed that SFTID was morally equivalent to euthanasia, and 85% disagreed or strongly disagreed that SFTID was legally equivalent to euthanasia. For the case scenarios, 92% agreed or strongly agreed that SFTID was acceptable for imminently dying patients with metastatic cancer, while 50% agreed or strongly agreed that SFTID was acceptable for patients with end-stage amyotrophic lateral sclerosis, and only 7% agreed or strongly agreed that SFTID was acceptable for posttraumatic quadriplegic patients not at risk for imminent death.


CONCLUSIONS
The overwhelming majority of neurologists surveyed endorse the concept that sedation for the imminently dying differs morally and legally from euthanasia and that it is an acceptable therapeutic option for some but not all patients who are imminently dying of a terminal illness.
Department of Neurology, Lahey Clinic, Burlington, MA 01805, USA. james.a.russell@lahey.org
James A
JA
Russell
Michael A
MA
Williams
Oksana
O
Drogan
D000690:Amyotrophic Lateral Sclerosis / Q000150:complications; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D016292:Procedural Sedation / Q000941:ethics* / Q000592:standards; D003469:Culture; D003625:Data Collection; D003657:Decision Making / Q000941:ethics; D004992:Ethics, Medical; D005065:Euthanasia / Q000941:ethics; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009369:Neoplasms / Q000150:complications; D009462:Neurology / Q000941:ethics* / Q000592:standards; D010148:Intractable Pain / Q000188:drug therapy* / Q000517:prevention & control; D010166:Palliative Care / Q000941:ethics* / Q000379:methods / Q000592:standards; D010819:Physician's Role; D010817:Physician-Patient Relations / Q000941:ethics; D010818:Practice Patterns, Physicians' / Q000941:ethics* / Q000592:standards / Q000706:statistics & numerical data; D011782:Quadriplegia / Q000150:complications; D011788:Quality of Life; D012297:Right to Die / Q000941:ethics; D012955:Societies, Medical / Q000941:ethics / Q000592:standards; D013315:Stress, Psychological / Q000188:drug therapy / Q000517:prevention & control; D019452:Terminally Ill