title: Expanding the Use of Continuous Sedation Until Death: Moving Beyond the Last Resort for the Terminally Ill.
abstract: As currently practiced, the use of continuous sedation until death (CSD) is controlled by clinicians in a way that may deny patients a key choice in controlling their dying process. Ethical guidelines from the American Medical Association and the American Academy of Pain Medicine describe CSD as a "last resort," and a position statement from the American Academy of Hospice and Palliative Medicine describe it as "an intervention reserved for extreme situations." Accordingly, patients must progress to unremitting pain and suffering and reach a last-resort stage before the option to pursue CSD is considered. Alternatively, we present and defend a new guideline in which decisionally capable, terminally ill patients who have a life expectancy of less than six months may request CSD before being subjected to the refractory suffering of a treatment of "last resort."
authors.affiliation: Cuyahoga Community College, Western Campus, Department of Philosophy, 11000 Pleasant Valley Rd., Parma, OH 44103-5150 USA. Samuel.lipuma@tri-c.edu.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: LiPuma
authors.affiliation: Cleveland State University, Department of Philosophy, 2121 Euclid Ave., RT 1932, Cleveland, Ohio 44115-2214 USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: DeMarco
mesh_terms: D002755:Choice Behavior / Q000941:ethics; D003643:Death; D003657:Decision Making / Q000941:ethics*; D054810:Deep Sedation / Q000941:ethics*; D033101:Euthanasia, Active, Voluntary / Q000941:ethics / Q000331:legislation & jurisprudence / Q000639:trends; D006282:Health Personnel / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D017051:Hospice Care / Q000941:ethics; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000592:standards; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D028681:Moral Obligations; D009426:Netherlands; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000941:ethics*; D010147:Pain Measurement; D010166:Palliative Care / Q000941:ethics* / Q000379:methods / Q000639:trends; D018802:Patient-Centered Care / Q000941:ethics* / Q000379:methods / Q000639:trends; D026684:Personal Autonomy; D017410:Practice Guidelines as Topic; D011639:Public Opinion; D012945:Social Values; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary; D013315:Stress, Psychological / Q000517:prevention & control; D017236:Suicide, Assisted / Q000941:ethics / Q000331:legislation & jurisprudence / Q000639:trends; D013727:Terminal Care / Q000941:ethics* / Q000379:methods / Q000639:trends; D019452:Terminally Ill; D013997:Time Factors; D016312:Treatment Refusal; D014342:Truth Disclosure / Q000941:ethics; D035501:Uncertainty; D014481:United States; D028761:Withholding Treatment / Q000941:ethics