Christian Worldview Concepts

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

Does Terminal Sedation Undermine the Long-Held Tradition of Hospice?

Due to lingering misconceptions, hospice workers must continuously strive to assure patients and their families that hospice does not practice euthanasia. The goal of hospice is to provide dying patients with the highest quality of life for however much time they have to live. While hospice patients are diagnosed as terminal, which means death is expected to occur within a year, this in no way means hospice workers "ensure" that death occurs within this one year window.

Terminal sedation appears to undermine the core values of hospice by involving hospice personnel in a protocol that is intended to result in the patient's death — a hastened death — and because of the not-so-subtle message being sent to other hospice patients that perhaps they, too, should spare their loved ones the additional "burden" and choose a quicker death. While many hospice patients die in their homes, away from other terminal patients, the educational effect of inducing unconsciousness and removal of supportive care undoubtedly spills over to other patients and other families. Furthermore, if terminal sedation is indeed killing, it most definitely violates the care giving tradition of hospice.

Is the latter charge somewhat mitigated by the nature of the person's suffering? Must we keep a dying person conscious for as long as possible? Do Christian ethical principles require a terminally ill person to remain conscious throughout the dying process? The answer to all of these questions is simply this: a person is not morally required to consciously experience all of the pain and suffering their dying might entail, therefore, the appropriate use of pain and sedating medications is an acceptable form of comfort care. However, to make a person permanently unconscious and withdraw or withhold food and fluids is not comfort care — it is killing, and by definition it violates the care giving tradition of hospice. For these reasons, the Christian physician may not utilize terminal sedation as an ethically valid form of treatment.