title: Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.
abstract: Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death.
authors.affiliation: Division of Palliative Medicine, National Cancer Centre, Singapore.|Duke-NUS Medical School, National University of Singapore, Singapore.
authors.forename: Tze Ling Gwendoline Beatrice
authors.initials: TL
authors.lastname: Soh
authors.affiliation: Division of Palliative Medicine, National Cancer Centre, Singapore.|Duke-NUS Medical School, National University of Singapore, Singapore.|Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Lalit Kumar Radha
authors.initials: LK
authors.lastname: Krishna
authors.affiliation: Division of Palliative Medicine, National Cancer Centre, Singapore.
authors.forename: Shin Wei
authors.initials: SW
authors.lastname: Sim
authors.affiliation: Division of Palliative Medicine, National Cancer Centre, Singapore.|Duke-NUS Medical School, National University of Singapore, Singapore.
authors.forename: Alethea Chung Peng
authors.initials: AC
authors.lastname: Yee
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003643:Death; D054810:Deep Sedation / Q000941:ethics*; D004992:Ethics, Medical; D005065:Euthanasia / Q000941:ethics* / Q000331:legislation & jurisprudence; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D010166:Palliative Care / Q000941:ethics*; D028723:Personhood; D010686:Philosophy, Medical; D017410:Practice Guidelines as Topic; D017236:Suicide, Assisted / Q000941:ethics* / Q000331:legislation & jurisprudence; D013727:Terminal Care / Q000941:ethics*; D014474:Unconsciousness
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives
keywords: Ring Theory of Personhood; continuous sedation until death; palliative care; personhood; terminal sedation