Terminal Sedation- Where Are We Now?

Imagine that you are a patient care worker in a busy faith based hospital system, with more than 600 beds. You are assigned to work on a floor with patients suffering from various forms of cancer and other terminal illnesses; the average patient in this area probably will not make it out of the hospital. One of your patients, Mr. No Name has a history of terminal cancer and emphysema.

He has been ill a long time and his physicians have given him a few days to live. As the days progress, most of Mr. No Name's treatments are stopped, and he is not eating. After careful No one actually knows when the first case of palliative sedation was given, but it has been the center of controversy for quite some time. In a 1914 court case, the New York Supreme Court set a precedent for patient autonomy that set the stage for palliative sedation in the United States (Battle 1). As noted in the Battle article, in this decision the courts ruled that "'every human being of adult years and sound mind has a right to determine what shall be done with his own body'" (Battle 2279).

Furthermore, in the article by Valko it was noted that in 1957, the Vatican's Declaration on

Furthermore, terminal sedation continues to be used as an accepted form of palliative therapy. Its use is has been sanctioned by the Supreme Court of the United States and the Catholic Church. However its use remains as controversial as ever, and some clinicians remain uneasy when this form of sedation is used. For example I queried my staff members a few days ago concerning terminal sedation and its use at our facility. They informed me that we continue to administer this form of sedation, but they were not comfortable with its application nor were they comfortable talking about it. Unfortunately, this is not an uncommon response. In researching this topic, I found a lot of related information, but it was difficult to find very specific information. Furthermore, it was very difficult to find information that originated in the United States. Most of the studies and reviews that I found originated in Europe where this type of procedure is controversial, but accepted. Terminal sedation is used in the United States, however it appears that the controversy surrounding its use prohibit research in this area. Most of the articles written in this area were either case report of an editorial nature.

Much of the controversy surrounding the use of terminal sedation centers on the distinction between it and assisted suicide. Unfortunately, euthanasia, which is illegal, has received so much publicity in the past that any form of therapy legal or illegal, is categorized as euthanasia. In some respects, the stigma of practicing euthanasia may cause some patients, families and clinicians to have second thoughts about the use of terminal sedation. However, when confronted with this issue it is important to remember that this process is legal, as long as the intent of those involved