Christian Worldview Concepts

The Ethics of Terminal Sedation as a Treatment for End-of-Life Pain and Suffering

Introduction

Give beer to those who are perishing, wine to those who are in anguish; let them drink and forget their poverty and remember their poverty no more - Proverbs 31:6, 7 (NIV)

The writer of Proverbs seems to lend credibility to the notion that we should sedate those who suffer. The Greek philosopher, Socrates, is credited with having said, "Young men fear death; old men fear dying." Young men fear the loss of all they might have accomplished and experienced over a normal life span, while old men, having experienced whatever life had to offer them, fear the dying process itself. In the modern age where control and efficiency are the crowning virtues, people fear of dying alone, dying in pain and being a burden on others. They fear the kind of dying process that modern medicine is capable of inducing.

The debates over legalizing physician assisted suicide and euthanasia have grown more intense in recent years, fueled by the dwindling influence of Judeo-Christian ethics, an aging population and rising health care costs. Oregon already permits physician-assisted suicide and Hawaii's legislature narrowly defeated a similar law by a mere three votes.

Terminal sedation is portrayed as a way to reconcile the objections to physician assisted suicide/euthanasia while providing the maximum in comfort care. Its proponents argue that it is an ethical and humane means of addressing the needs of the dying. Despite the improvements in pain and symptom management for terminal patients, a small number of patients continue to experience severe pain and other distressing symptoms that many would consider intolerable. In response to this small percentage of terminal patients, some caregivers believe terminal sedation is warranted.

Terminal sedation is the term that describes a form of end-of-life treatment that has gained increasing acceptance among both ethicists and physicians, in part because they view the practice as a valid alternative to physician-assisted suicide for those patients whose pain and suffering cannot be relieved by existing pain management techniques. In this article, I will explore the nature of this form of palliative (comfort) care and discuss the ethical issues that it presents for the Christian medical practitioner, patients and families.