Topics in Medical Therapy: Terminal Sedation To the Instructor: This Power Point presentation is a suggested slide presentation that can be used for lecture. It was created from the information in Instruction Material/ Content section of the TNEEL CD-ROM. If the presentation includes some audio sound and video clips, click the red button to play the sound or video. For some sets of slides, there will be suggestions and detail descriptions throughout this Power Point presentation in the “Notes Page.” These notes are for instructor’s use only, and are not intended for distribution to the students. Thank you for using TNEEL. We welcome any suggestions. Sarah E. Shannon, PhD, RN Topics in Medical Therapy: Terminal Sedation Ethical Issues Around the Practice of Terminal Sedation © Copyright By Sarah E. Shannon

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. The definition of what constitutes terminal sedation does not have universal agreement. Most people 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.

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. Terminal sedation is legal in America. Most people agree that terminal sedation is “sedation for intractable distress in the dying.” A small sample of physicians and nurses reported that 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.

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. ·One argument in favor of terminal sedation is that intractable suffering, particularly suffering that cannot be easily treated with medication such as existential suffering, deserves to be treated as aggressively as physical pain would be treated. Hence, since we tolerate a diminished consciousness to achieve relief of physical pain, we ought to tolerate a diminished level of consciousness to treat other kinds of suffering. A pragmatic argument for using terminal sedation is to reassure the public that people will not be forced to die in pain even if it means that the person is sedated to unconsciousness. This argument could remove the public’s justifiable fear of pain at death.

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. Some clinicians fear that aggressive management of pain and suffering will lead to them being accused of assisted suicide, mercy killing, or euthanasia – in particular when, as clinicians, these acts are against their moral or professional beliefs. Some clinicians believe that certain types of suffering can be treated with terminal sedation while other types should not. For example, physical pain versus existential suffering. Some clinicians may believe that being conscious has great value during the last days or weeks of life. The most compelling reason to not use terminal sedation is that it is likely to hasten death due to the physiological effects of immobility. These effects include the fact that fluid and food intake will decrease or stop all together, secretions may accumulate in the lungs, circulation will be affected, etc.