title: Contesting the Equivalency of Continuous Sedation until Death and Physician-assisted Suicide/Euthanasia: A Commentary on LiPuma.
abstract: Patients who are imminently dying sometimes experience symptoms refractory to traditional palliative interventions, and in rare cases, continuous sedation is offered. Samuel H. LiPuma, in a recent article in this Journal, argues that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia based on a higher brain neocortical definition of death. We contest his position that continuous sedation involves killing and offer four objections to the equivalency thesis. First, sedation practices are proportional in a way that physician-assisted suicide/euthanasia is not. Second, continuous sedation may not entirely abolish consciousness. Third, LiPuma's particular version of higher brain neocortical death relies on an implausibly weak construal of irreversibility--a position that is especially problematic in the case of continuous sedation. Finally, we explain why continuous sedation until death is not functionally equivalent to neocortical death and, hence, physician-assisted suicide/euthanasia. Concluding remarks review the differences between these two end-of-life practices.
authors.affiliation: University of California, Los Angeles, Los Angeles, California, USA Cancer Prevention and Research Institute (ISPO), Florence, Italy joeraho@gmail.com.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Raho
authors.affiliation: University of California, Los Angeles, Los Angeles, California, USA Cancer Prevention and Research Institute (ISPO), Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Miccinesi
mesh_terms: D054810:Deep Sedation / Q000941:ethics*; D006801:Humans; D010166:Palliative Care / Q000941:ethics*; D017236:Suicide, Assisted / Q000941:ethics*; D013727:Terminal Care / Q000941:ethics*
keywords: continuous sedation until death; higher brain death; palliative care; proportionality; reversibility