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European Association for Palliative Care (EAPC) framework for palliative sedation an ethical discussion.doc

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European Association for Palliative Care (EAPC) framework for palliative sedation an ethical discussion

Juthetal.BMCPalliativeCare2010,9:20 /1472-684X/9/20 DEBATE OpenAccess EuropeanAssociationforPalliativeCare(EAPC) frameworkforpalliativesedation:anethical discussion NiklasJuth*,AnnaLindblad,NielsLyn?e,ManneSj?strand,GertHelgesson Abstract Background:Theaimofthispaperistocriticallydiscusssomeoftheethicallycontroversialissuesregarding continuousdeeppalliativesedationattheendoflifethatareaddressedintheEAPCrecommendedframeworkfor theuseofsedationinpalliativecare. Discussion:WearguethattheEAPCframeworkwouldhavebenefitedfromtakingaclearerstandontheethically controversialissuesregardingintolerablesufferingandrefractorysymptomsandregardingtherelationbetween continuousdeeppalliativesedationattheendoflifeandeuthanasia.Itisunclearwhatconstitutesrefractory symptomsandwhattherelationshipisbetweenrefractorysymptomsandintolerablesuffering,whichinturn makesitdifficulttodeterminewhatarenecessaryandsufficientcriteriaforpalliativesedationattheendoflife, andwhy.Asregardsthedifferencebetweenpalliativesedationattheendoflifeandso-calledsloweuthanasia, therationalebehindstressingthedifferenceisinsufficientlydemonstrated,e.g.duetoanoverlookedambiguityin theconceptofintention.Itisthereforeunclearwhenpalliativesedationattheendoflifeamountstoabuseand why. Conclusions:TheEAPCframeworkwouldhavebenefitedfromtakingaclearerstandonsomeethically controversialissuesregardingintolerablesufferingandrefractorysymptomsandregardingtherelationbetween continuousdeeppalliativesedationattheendoflifeandeuthanasia.Inthistext,weidentifyanddiscussthese issuesinthehopethatanensuingdiscussionwillclarifytheEAPC’ sstandpoint. Background someofitscontent.Takenasawhole,wethinkthatthe Palliative sedation at the end of life is much debated, EAPC framework presents excellent procedural guide- sinceitinvolves ethically controversial issues regarding linesforpalliativecare.Itbothmotivatestheimportance thegoodlifeanddeath[1],borderingonhotlycontested of procedural guidelines and pinpoints the key clinical issues reg