gms | German Medical Science

Introduction: Stressful symptoms in seriously ill and dying persons can be reduced tolerably in most patients by means of palliative measures. Nevertheless, in a number of patients a bearable state cannot be accomplished even if physical, mental, social and spiritual needs are taken care of. In such extreme cases terminal sedation is an effective option. Terminal sedation is internationally widespread and especially in palliative care regarded as a common therapeutic option. Nevertheless, the term and the ethical evaluation of terminal sedation are controversially discussed. While many physicians and nurses working in care for seriously ill and dying people approve of terminal sedation as a (last) palliative treatment option, others regard it as a form of “slow euthanasia”.

Methods: In an interdisciplinary project persons dealing with medical ethical issues were interviewed on the term and the ethical evaluation of terminal sedation.

Results: 283 persons (> 59% of the members) took part in the investigation, hereof 60% physicians. The term palliative sedation (47%) was preferred to terminal sedation (40%).

96% of the respondents accepted a continuous sedation till death occurred in order to treat severe pain in dying patients, but only 71% accepted a persistent sedation in patients in incurable states.

If the untreatable symptom was a cancer-dependent depression, approval accounted for 60% for dying patients but only for 38% for patients in incurable states. If terminal sedation was combined with withdrawing of artificial feeding the acceptance was still lower. 47% of the interviewed persons implicated unconsciousness with terminal sedation whereas this was not important for 51%.

Conclusions: Terminal sedation for intractable distress has raised considerable medical and ethical concerns. These depend on the stage of disease, the prevalence of symptoms, the type and duration of sedation, the nutrition supply and the state of consciousness under therapy.