ĭifferentiating Palliative Sedation from Euthanasia and Physician-assisted Suicide Other countries where physician-assisted suicide is legal are Canada, Belgium, the Netherlands, Luxembourg, and Switzerland. In the United States, PAS is legal in California, Colorado, the District of Columbia, Hawaii, Montana, Maine, New Jersey, Oregon, Vermont, and Washington. In these states, "death with dignity" statutes ensure that mentally competent adult state residents who have a terminal illness with a confirmed prognosis of having 6 or fewer can voluntarily request a prescription for medication that hasten death. It differs from euthanasia in that the health care worker assumes a passive role of supervision, and the actual administration of medication that leads to death has to be done by the patients on their own. Physician-assisted suicide (PAS) is the process by which a physician acts as a facilitator for a patient to hasten death by providing lethal doses of prescription medication. Netherlands and Belgium are currently the only two that allow health care workers to participate in voluntary euthanasia. The practice of involuntary euthanasia is illegal in all countries. It can either be done with the patient's consent (voluntary euthanasia) or done independently by the health care providers (involuntary euthanasia). Below, we will briefly describe the fundamental concept and differences between these therapies in terminally ill patients.Įuthanasia constitutes the process by which a health care worker taking care of the patient intentionally uses medications to terminate a patient's life to end their pain and suffering. Due to this concern, the practice of palliative sedation is still compared with physician-assisted suicide and euthanasia. Most clinicians and organizations' chief concern from administering palliative sedation in patients is that it may inadvertently hasten or quicken someone's demise. Well-documented goals of care discussion with the patient or surrogates must be present to outline the plan of care and potential risks of using palliative sedation.Įthical and Legal Issues Īlthough there has been a well-demonstrated benefit of better symptom control in patients with a terminal illness, the topic of providing palliative sedation continues to garner some controversy. This article presents a concise review of indications of palliative sedation, legal/ethical issues associated with its use, common misconceptions, and pharmacological agents used for the purpose. Furthermore, several misconceptions regarding palliative care issues, including hospice, pain control, and palliative sedation, remain inpatients, and their families. Other studies have shown variability in the practice of continuation sedation in palliative care of patients. Prior studies have demonstrated several communication barriers between clinicians, patients, and surrogates that prevent timely planning for end-of-life issues leading to increased anxiety and frustrations towards the medical team. Additionally, ethical and legal issues surrounding this topic as it appears, at least superficially similar to the process of physician-assisted suicide or euthanasia, discourage physicians from initiating conversations or planning for palliative sedation in patients. This is partly due to the lack of consistency in defining "refractory symptoms" and lack of adequate knowledge in patients, family members, and health care workers alike regarding the issue of palliative sedation. Despite clear palliative benefits in patients, the use of palliative sedation remains quite controversial. The most common refractory symptoms for palliative sedation are delirium, intractable pain, and shortness of breath. It involves therapy targeted at resolving or alleviating refractory symptoms at the end of life. Palliative sedation encompasses a broad range of activities aimed at relieving distress in terminally ill patients.
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