Abstract
Background"Terminal sedation" regarded as the use of sedation in (pre-)terminal patients with treatment-refractory symptoms is controversially discussed not only within palliative medicine. While supporters consider terminal sedation as an indispensable palliative medical treatment option, opponents disapprove of it as "slow euthanasia". Against this background, we interviewed medical ethics experts by questionnaire on the term and the moral acceptance of terminal sedation in order to find out how they think about this topic. We were especially interested in whether experts with a professional medical and nursing background think differently about the topic than experts without this background.MethodsThe survey was carried out by questionnaire; beside the provided answering options free text comments were possible. As test persons we chose the 477 members of the German Academy for Ethics in Medicine, an interdisciplinary society for medical ethics.Results281 completed questionnaires were returned (response rate = 59%). The majority of persons without medical background regarded "terminal sedation" as an intentional elimination of consciousness until the patient's death occurs; persons with a medical background generally had a broader understanding of the term, including light or intermittent forms of sedation. 98% of the respondents regarded terminal sedation in dying patients with treatment-refractory physical symptoms as acceptable. Situations in which the dying process has not yet started, in which untreatable mental symptoms are the indication for terminal sedation or in which life-sustaining measures are withdrawn during sedation were evaluated as morally difficult.ConclusionThe survey reveals a great need for research and discussion on the medical indication as well as on the moral evaluation of terminal sedation. Prerequisite for this is a more precise terminology which describes the circumstances of the sedation.
Highlights
According to the definition of the World Health Organization (WHO) palliative medicine aims to enhance quality of life in patients suffering from an incurable disease [1].When dealing with treatment-refractory symptoms it is a possibility to sedate patients in order to obtain satisfactory symptom control
Against the background of these different attitudes, we interviewed German-speaking medical ethics experts by questionnaire on the term and the moral acceptance of terminal sedation in order to find out how they think about this topic
On the understanding of the term In question 2, the medical ethics experts were asked about their understanding of the term "terminal sedation"; for this, two possible answers were provided with regard to intention, depth and manner of sedation
Summary
According to the definition of the World Health Organization (WHO) palliative medicine aims to enhance quality of life in patients suffering from an incurable disease [1].When dealing with treatment-refractory symptoms it is a possibility to sedate patients in order to obtain satisfactory symptom control. According to the definition of the World Health Organization (WHO) palliative medicine aims to enhance quality of life in patients suffering from an incurable disease [1]. In 1991, the use of sedation in imminently dying patients was called "terminal sedation". While supporters regard terminal sedation as an indispensable palliative medical treatment option, opponents disapprove of it as "slow euthanasia" [3,4]. Only a few valid empirical data on the use of sedation to treat refractory symptoms in terminally ill patients are available. From the Netherlands it is known that terminal sedation is used in up to 10% of dying patients [5,6]. One can find alternative terms like "palliative sedation" [10,14,15] or "sedation at the end of life" [16,17]
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