Citation

Tze-Ling-Gwendoline-Beatrice SOH, Lalit-Kumar-Radha KRISHNA, Sim SW, Alethea-Chung-Peng YEE. Singapore Med. J. 2016; 220-227.

Copyright

(Copyright © 2016, Singapore Medical Association)

DOI

10.11622/smedj.2016086

PMID

unavailable

Abstract

Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death.

Language: en

Keywords

palliative care; personhood; terminal sedation; continuous sedation until death; Ring Theory of Personhood