Controversies surrounding continuous deep sedation at the end of life: the parliamentary and societal debates in France.

Kasper Raus,Sigrid Sterckx,Kenneth Chambaere

doi:10.1186/s12910-016-0116-2

Kasper Raus, Sigrid Sterckx + Show 1 more

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https://doi.org/10.1186/s12910-016-0116-2

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Abstract

BackgroundContinuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying. The practice is generally considered to be legal as a form of symptom control, although this is mostly only assumed. France has passed an amendment to the Public Health Act that would grant certain terminally ill patients an explicit right to continuous deep sedation until they pass away. Such a framework would be unique in the world.DiscussionIn this paper we will highlight and reflect on four relevant aspects and shortcomings of the proposed bill. First, that the bill suggests that continuous deeps sedation should be considered as a sui generis practice. Second, that it requires that sedation should always be accompanied by the withholding of all artificial nutrition and hydration. In the most recently amended version of the legal proposal it is stated that life sustaining treatments are withheld unless the patient objects. Third, that the French bill would not require that the suffering for which continuous deep sedation is initiated is unbearable. Fourth, the question as to whether the proposal should be considered as a way to avoid having to decriminalise euthanasia and/or PAS or, on the contrary, as a veiled way to decriminalise these practices.SummaryThe French proposal to amend the Public Health Act to include a right to continuous deep sedation for some patients is a unique opportunity to clarify the legality of continuous deep sedation as an end-of-life practice. Moreover, it would recognize that the practice of continuous deep sedation raises ethical and legal issues that are different from those raised by symptom control on the one hand and assisted dying on the other hand. Nevertheless, there are still various issues of significant ethical concern in the French legislative proposal.

Highlights

Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying
Summary: The French proposal to amend the Public Health Act to include a right to continuous deep sedation for some patients is a unique opportunity to clarify the legality of continuous deep sedation as an end-of-life practice
The debate on sedation is very lively in France, where an amendment to the Public Health Act was made to include an explicit right for terminally ill patients to 'deep and continuous sedation' [7]

Summary

Discussion

Is continuous deep sedation a sui generis practice and does it require a separate law? There is considerable international debate on whether or not continuous deep sedation is a sui generis practice. The decision to stop artificial hydration and nutrition often seems to be in accordance with the French proposal’s goal ‘to not unnecessarily prolong the patient’s life’ [7] It is crucial, not to invoke the fact that a patient is deeply and continuously sedated as a reason to withhold or withdraw ANH, since this is a ‘salamislicing technique’ [29] to justify the latter decision merely by reference to a (sedated) state that one has created oneself. While some commentators suggest that a right to continuous deep sedation was proposed in order to avoid having to decriminalise physician-assisted suicide or euthanasia, others believe the legislative proposal is a disguised way to allow medically assisted life shortening. [O]ur anxiety that [sedation] may be confused with euthanasia encourages us to obscure or sanitize the features both practices share ([1], p.29)

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