Continuous Sedation at the End of Life: Ethical, Clinical and Legal Perspectives(Cambridge Bioethics and Law)

Continuous sedation until death (sometimes referred to as terminal sedation or palliative sedation) is an increasingly common practice in end-of-life care. However, it raises numerous medical, ethical, emotional and legal concerns, such as the reducing or removing of consciousness (and thus potentially causing 'subjective death'), the withholding of artificial nutrition and hydration, the proportionality of the sedation to the symptoms, its adequacy in actually relieving symptoms rather than simply giving onlookers the impression that the patient is undergoing a painless 'natural' death, and the perception that it may be functionally equivalent to euthanasia. This book brings together contributions from clinicians, ethicists, lawyers and social scientists, and discusses guidelines as well as clinical, emotional and legal aspects of the practice. The chapters shine a critical spotlight on areas of concern and on the validity of the justifications given for the practice, including in particular the doctrine of double effect.

Table of Contents:
1. Introduction Sigrid Sterckx, Kasper Raus and Freddy Mortier; 2. Continuous sedation until death: state of the art Sophie Bruinsma, Judith Rietjens and Agnes van der Heide; 3. Death by equivocation: a manifold definition of terminal sedation David Albert Jones; 4. Palliative sedation: clinical, pharmacological and practical aspects Josep Porta-Sales; 5. Clinical aspects of palliative sedation Nigel Sykes; 6. Understanding the role of nurses in the management of symptoms and distress in the last days of life Eleanor Wilson and Jane Seymour; 7. Principle and practice for palliative sedation: gaps between the two David Orentlicher; 8. The legal permissibility of continuous deep sedation at the end of life: a comparison of laws and a proposal Evelien Delbeke; 9. The Dutch national guideline on palliative sedation Johan Legemaate; 10. Continuous deep sedation at the end of life: balancing benefits and harms in England, Germany and France Richard Huxtable and Ruth Horn; 11. Can the doctrine of double effect justify continuous deep sedation at the end of life? Kasper Raus, Sigrid Sterckx and Freddy Mortier; 12. Palliative sedation, consciousness and personhood Timothy Holahan, Thomas Carroll, Claudia Gonzalez and Timothy Quill; 13. The ethical evaluation of continuous sedation at the end of life Johannes van Delden; 14. Terminal sedation and euthanasia – the virtue in calling a spade what it is Søren Holm; 15. Terminal sedation: recasting a metaphor as the ars moriendi changes Margaret Battin.

About the Author :
Sigrid Sterckx is a Professor of Ethics at Ghent University and at the Vrije Universiteit Brussel (VUB) in Belgium. Kasper Raus is a postdoctoral researcher at Ghent University, Belgium. Freddy Mortier is a Professor of Ethics at Ghent University, Belgium.

Review :
'Continuous Sedation at the End of Life offers a thorough and thoughtful analysis of a complex and vexing issue. It successfully spans disciplines and jurisdictions as it provides clinical and epidemiological evidence about - and legal and ethical analyses of - a practice that is in real need of careful attention. By helping us to see that continuous sedation at the end of life needs to be (and how it can be) better understood, monitored, and regulated, this book has the potential to meaningfully contribute to the improvement of care of the dying across the globe.' Jocelyn Downie, Dalhousie University, Nova Scotia 'This book is clearly a treat to read and digest. As any clinician in palliative care knows, palliative sedation at the end of life is complex. It requires careful communication within the clinical team and, of course, with patients and families. This text mentors the reader to be mindful of all aspects of palliative sedation from the practical aspects, to the ethical dilemmas and the legal frameworks. It explores the challenges faced every day in attempting to meet patients' and families' needs near the end of life. A must-read for all professionals working in or researching palliative care.' Sheila Payne, President, European Association for Palliative Care 'This thoughtful volume assembles the reflections of leading ethicists, physicians, social researchers and others on the important topic of sedation in end of life care. Of growing importance in the toolkit available for the relief of suffering in the palliative care of dying patients, the relatively new technology of sedation raises many ethical issues which the authors outline in insightful, often original and always informative ways. The combining of perspectives from clinicians and academics is particularly valuable and the editorial introduction provides a masterful summary of the issues involved. This book is destined to be a classic contribution to clinical ethics.' Clive Seale, Brunel University 'For anyone who wants an in-depth, comprehensive and balanced understanding of the clinical and ethical issues surrounding continuous sedation at the end of life, this book is the place to go. The subject is more complex than most people realize and the authors' contributions are extremely helpful in teasing apart and identifying the critical issues.' Stuart Youngner, Case Western Reserve University, Ohio