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Sarah E. Shannon, PhD, RN Topics in Medical Therapy: Terminal Sedation Ethical Issues Around the Practice of Terminal Sedation © Copyright By Sarah E. Shannon Ethical Issues Around the Practice of Terminal Sedation Topics in Medical Therapy: Terminal Sedation The definition of what constitutes terminal sedation does not have universal agreement but most consider it to be providing sedation that achieves a state of unconsciousness while maintaining a respiratory drive for a period prior to the patient's death. TNEEL-NE Slide 2 Ethical Issues Around the Practice of Terminal Sedation Background Issues • Terminal sedation is legal in America. • Study of physicians and nurses: 79% believed terminal sedation was sometimes necessary to treat intractable distress in dying patients and 77% reported using it in the past year. • Terminal sedation is distinct from euthanasia in that it is viewed as a tool for the management of intractable symptoms of suffering rather than as a tool to elicit death. TNEEL-NE Slide 3 Ethical Issues Around the Practice of Terminal Sedation Reasons for Not Using Terminal Sedation • Fear of being accused of assisting suicide, mercy killing, or euthanasia particularly when it is against moral beliefs. • Belief that certain types of suffering should be treated with terminal sedation while others should not; i.e., physical pain versus existential suffering. • Belief that being conscious has great value during the last days or weeks of life. • Terminal sedation may hasten death through immobility. TNEEL-NE Slide 4 Ethical Issues Around the Practice of Terminal Sedation Reasons for Using Terminal Sedation • To aggressively treat suffering whether it is physical or existential suffering. • Remove a patient’s justifiable fear of pain at death and reassure them that they will not be forced to die in pain even if it means that they will be sedated to unconsciousness. TNEEL-NE Slide 5