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Continuous Sedation at the End of Life
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Book description

Continuous sedation until death (sometimes referred to as terminal sedation or palliative sedation) is an increasingly common practice in end-of-life care. However, it raises numerous medical, ethical, emotional and legal concerns, such as the reducing or removing of consciousness (and thus potentially causing 'subjective death'), the withholding of artificial nutrition and hydration, the proportionality of the sedation to the symptoms, its adequacy in actually relieving symptoms rather than simply giving onlookers the impression that the patient is undergoing a painless 'natural' death, and the perception that it may be functionally equivalent to euthanasia. This book brings together contributions from clinicians, ethicists, lawyers and social scientists, and discusses guidelines as well as clinical, emotional and legal aspects of the practice. The chapters shine a critical spotlight on areas of concern and on the validity of the justifications given for the practice, including in particular the doctrine of double effect.

Reviews

'Continuous Sedation at the End of Life offers a thorough and thoughtful analysis of a complex and vexing issue. It successfully spans disciplines and jurisdictions as it provides clinical and epidemiological evidence about - and legal and ethical analyses of - a practice that is in real need of careful attention. By helping us to see that continuous sedation at the end of life needs to be (and how it can be) better understood, monitored, and regulated, this book has the potential to meaningfully contribute to the improvement of care of the dying across the globe.'

Jocelyn Downie - Dalhousie University, Nova Scotia

'This book is clearly a treat to read and digest. As any clinician in palliative care knows, palliative sedation at the end of life is complex. It requires careful communication within the clinical team and, of course, with patients and families. This text mentors the reader to be mindful of all aspects of palliative sedation from the practical aspects, to the ethical dilemmas and the legal frameworks. It explores the challenges faced every day in attempting to meet patients’ and families’ needs near the end of life. A must-read for all professionals working in or researching palliative care.'

Sheila Payne - President, European Association for Palliative Care

'This thoughtful volume assembles the reflections of leading ethicists, physicians, social researchers and others on the important topic of sedation in end of life care. Of growing importance in the toolkit available for the relief of suffering in the palliative care of dying patients, the relatively new technology of sedation raises many ethical issues which the authors outline in insightful, often original and always informative ways. The combining of perspectives from clinicians and academics is particularly valuable and the editorial introduction provides a masterful summary of the issues involved. This book is destined to be a classic contribution to clinical ethics.'

Clive Seale - Brunel University

'For anyone who wants an in-depth, comprehensive and balanced understanding of the clinical and ethical issues surrounding continuous sedation at the end of life, this book is the place to go. The subject is more complex than most people realize and the authors' contributions are extremely helpful in teasing apart and identifying the critical issues.'

Stuart Youngner - Case Western Reserve University, Ohio

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Contents

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Laws

  • Belgium – Wet van 14 juni 2002 betreffende palliatieve zorg (Act on Palliative Care). Belgisch Staatsblad 26 October 2002.

  • Belgium – Article 403 Penal Code of 8 June 1867. Belgisch Staatsblad 9 June 1867.

  • Belgium – Wet van 22 augustus 2002 betreffende de rechten van de patiënt (Act on Patients’ Rights). Belgisch Staatsblad 26 September 2002.

  • England – Mental Capacity Act 2005.

  • France – Loi no 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie. (Law of 22 April 2005 relating to the rights of invalids at the end of life). Journal Officiel 23 April 2005, 59: 7089.

  • France – Code de la Santé Publique (Law on Public Health).

  • France – Code de Déontologie Médicale (Code of Medical Ethics).

  • Germany – Strafgesetzbuch (Criminal Law).

  • Germany – Grundgesetz (Fundamental Law).

  • Luxembourg – Loi du 16 mars 2009 relative aux soins palliatifs, à la directive anticipée et à l’accompagnement en fin de vie et modifiant 1. le Code de la sécurité sociale; 2. la loi modifiée du 16 avril 1979 fixant le statut général des fonctionnaires de l’Etat; 3. la loi modifiée du 24 décembre 1985 fixant le statut général des fonctionnaires communaux; 4. le Code du travail. Journal Officiel du Grand-Duché de Luxembourg, 16 March 2009, 610.

  • The Netherlands – Article 7:465 of the Civil Code.

  • The Netherlands – Medical Treatment Contracts Act. Law passed 17 November 1994 and effective 1 April 1995.

Court cases

Canada

Rodriguez v. British Columbia, 1993 CarswellBC 228 (Supreme Court of Canada 1993).

Europe

Case of Pretty v. the United Kingdom (Application No. 2346/02) (2002) 35 EHRR 1 (European Court of Human Rights 2002).

Germany

‘Dolantin’, NJW 1997:807 (Bundesgerichtshof– German Supreme Court 1996).
20 W 224/98, NJW 1998:2747–9 (Oberlandesgericht Frankfurt am Main – Higher Regional Court, Frankfurt 1988).
2 StR 454/09 (Bundesgerichtshof II Strafsenats – Supreme Court, 2nd Criminal Division 2010). Available at www.ethikzentrum.de/downloads/bgh-2010–06–25.pdf (last accessed 24 April 2013).

UK

Airedale NHS Trust v. Bland [1993] 2 WLR 316, [1993] AC 789 (House of Lords 1993).
R v. Adams [1957] Crim LR 365.
R (on the application of Purdy) v. Director of Public Prosecutions [2009] UKHL 45 (House of Lords 2009).
R (on the application of Tony Nicklinson) v. Ministry of Justice [2012] EWHC 2381 (Admin) (High Court 2012).
R v. Woollin [1998] 4 All ER 103, [1998] 3 WLR 382 (House of Lords 1998).
Re A (Children) (Conjoined Twins: Surgical Separation) [2000] EWCA Civ 254, [2000] 4 All ER 961 (Court of Appeal 2000).
Re B (Adult: Refusal of Medical Treatment) [2002] 2 All ER 449 (Court of Appeal).
W v. M and S and A NHS Primary Care Trust [2011] EWHC 2443 (High Court 2001).

USA

Vacco v. Quill, 521 U.S. 793 (US Supreme Court 1997).
Washington v. Glucksberg, 521 U.S. 702 (US Supreme Court 1997).