Discerning Palliative Sedation from Euthanasia: What’s at Stake for Human Dignity

 

Editor's Note: Parallel Paper Presentation from CBHD's 2009 Annual Conference, Global Bioethics: Emerging Challenges Facing Human Dignity

 

Abstract: The last presidential election saw Washington become the second state to legalize physician-assisted suicide (PAS).  Pressure will increase for other states to follow suit so that those who are terminally ill can exercise the full scope of their “autonomy” and “die with dignity” through PAS if they so choose. Many concerned persons see trends toward legalizing PAS and the broad acceptance of euthanasia as not upholding the inherent dignity of human persons as is often claimed, but actually undermining it. 

Christians engaged in palliative care have a responsibility to do what is permissible within theological, ethical, and legal boundaries to serve and treat their patients. Palliative sedation is thought to be an advance in palliative care that has alleviated the need for PAS when managing otherwise uncontrollable pain in the terminally ill. However, there is some question as to whether this procedure is sufficiently distinct from euthanasia and PAS. It may be argued that if there is no legitimate distinction, then PAS and other forms of euthanasia should be legal and legitimate end-of-life treatment options for patients along with palliative sedation.  If this view is correct, then Christians who support the use of sedation in the terminally ill should have no problem with the practice of PAS.

This issue is important for health care professionals, pastors, Christian counselors, chaplains, and others, who may be called upon to support patients and their families concerning end-of-life treatment options. This paper argues that there is a legitimate moral distinction between these practices and that those who oppose euthanasia while maintaining the appropriateness of palliative sedation in certain situations are not acting inconsistently. Thus, palliative sedation in some circumstances, as a form of palliative care for the terminally ill, is morally permissible and does not violate the intrinsic dignity of vulnerable patients.

 

Selected Bibliography

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  • Beauchamp, Thomas, and James Childress. Principles of Biomedical Ethics, 6th ed. (Oxford University Press, 2008).
  • Callahan, Daniel. “Organized Obfuscation: Advocacy for Physician-Assisted Suicide.” The Hastings Center Report 38, no. 5 (September-October 2008): 30–33.
  • Carr, Mark F., and Gina Mohr, “Palliative Sedation as Part of a Continuum of Palliative Care.” Journal of Palliative Medicine 11, no. 1 (2008): 76–81.
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  • Crenshaw, Jason. “Palliative Sedation for Existential Pain: An Ethical Analysis.” Journal of Hospice and Palliative Nursing 11, no. 2 (March/April 2009): 101–106.
  • Dyck, Arthur J. Life’s Worth: The Case against Assisted Suicide (Eerdmans, 2002).
  • Hauerwas, Stanley, and Charles Pinches. Christians among the Virtues. (University of Notre Dame, 1997).
  • Kilner, John. “Human Dignity.” In The Encyclopedia of Bioethics, 3rd ed. (Macmillan Reference, 1995), 1193–1200 .
  • Kingsbury, Robert J., and Howard M. Ducharme. “The Debate over Total/Terminal/Palliative Sedation.” The Center for Bioethics & Human Dignity, https://cbhd.org/content/two-perspectives-totalterminalpalliative-sedation  (accessed June 2009) .
  • Quill, Timothy E. “The Ambiguity of Clinical Intentions.” The New England Journal of Medicine 329, no. 14 (September 30, 1993): 1039–1040.
  • Quill, Timothy E., Rebecca Dresser, and Dan W. Brock. “The Rule of Double Effect—A Critique of Its Role in End-of-Life Decision Making.” The New England Journal ofMedicine, 337, no. 24 (December 11, 1997): 1768–1771.
  • Stewart, Tanya L. “‘To Sleep Before We Die…’: When is Palliative Sedation an Option for the Dying Person?” Journal of Palliative Medicine 11, no. 1 (2008): 131–132.
  • Sulmasy, Daniel P. “‘Reinventing’ the Rule of Double Effect.” In The Oxford Handbook of Bioethics, ed. Bonnie Steinbock (Oxford University Press, 2007).

 

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