The morality of terminal sedation

The treatment strategy known as "terminal sedation" (TS) is a challenging strategy both clinically and ethically. TS amounts to palliative treatment in the final hours and days of the life of a terminally ill patient, and is directed at refractory symptoms ? that is, symptoms against which conventional therapies have been tried unsuccessfully. Therefore, TS is a last resort form of treatment. The symptoms may be intolerable pain, shortness of breath, delirium, or persistent vomiting. By TS, we understand so-called deep sedation which implies unconsciousness ? not lighter forms of sedation in which the patient may be drowsy or partially awake. The state of unconscoiusness may be described as the eventual consequence of increasing dosages of medication for controlling symptoms; i.e., sedation unto unconsciousness. Alternatively, after having unsuccessfully tried to obtain symptom control, one gives up targeting the symptoms as such through increasing dosages, instead targeting and taking out the patient's consciousness so that he will no longer experience intolerable suffering. Some believe that TS is euthanasia in some instances. It is also claimed that TS shortens life. In addition, TS is said to entail the killing of persons since the patient's self awareness is eradicated. These claims are discussed. While acknowledging that TS may, due to a lack of clear criteria, openness and guidelines in relation to the treatment strategy, be abused as a concealed form of "slow euthanasia", we argue that TS has nothing to do with the intentional killing of patients. Rather, TS is appropriately labeled palliative sedation.