Executive Director - Euthanasia Prevention Coalition
Yesterday, I was interviewed by LifeSiteNews. The article is below.
I want to make it clear that Deep Sedation itself is not a moral problem, it becomes a moral problem when it is done with the intention of causing the persons death, usually by dehydration.
Deep Sedation is a very effective palliative technique for people who are suffering from intractable pain. This type of pain is less responsive to morphine. But good palliative care physicians know that you do not need to keep the person sedated until death in order to provide a great benefit for the person. Often a person can be sedated for several days and then brought out of sedation. That person has often experienced a physical relaxation that enables them to once again be awake without suffering from intractable pain.
Therefore, the proper use of Deep Sedation has benefits and should not be discouraged, but deep sedation can be abused whereby a person, who is not yet otherwise dying, is sedated and then dehydrated to death. This is a form of "slow" euthanasia.
British Doctors Practising "Slow" Euthanasia through Deep Sedation: BBC Report
By Hilary White
LONDON, August 18, 2009 (LifeSiteNews)
A BBC report has revealed that physicians in the UK are increasingly seeing and using "continuous deep sedation" as a form of "slow" euthanasia. Adam Brimelow, BBC News health correspondent, writes that the use of continuous deep sedation, also known as "terminal sedation" is becoming more common in the UK and may be the way physicians are skirting the law prohibiting direct euthanasia.
Research has shown that 16.5 percent of all deaths in the UK are associated with continuous deep sedation until death, a number twice that of Belgium and the Netherlands, both countries that already have legalised direct euthanasia.
Deep sedation can be used intermittently or continuously until death, and the depth of sedation can vary from a lowered state of consciousness to unconsciousness. Under UK law, patients can give a directive to medical staff that they refuse 'palliative care' or 'terminal sedation', or 'any drug likely to suppress respiration'.
Alex Schadenberg, the head of Canada's Euthanasia Prevention Coalition, said that continuous deep sedation is a technique that can be used ethically in cases of dying patients to alleviate intractable pain, such as neuropathic pain that does not respond to morphine, but the ethics depends upon the situation and the intention.
"It's important to make the distinction," Schadenberg told LifeSiteNews.com, "between what we do with someone who is nearing death and someone who is in pain but not dying." In some cases, he said, patients who are not dying but may be suffering are put into deep sedation, and then dehydrated to death - a use that is always unethical.
However, "if your patient is nearing death and is experiencing organ failure, you really can't be putting food and fluid into a body that can't use the fluids. When the body is shutting down, this is a natural part of the dying process. But when they're not dying, like Terri Schiavo, or someone who is experiencing great pain associated with cancer, that is a different issue, because then we are talking about causing that person's death.
"[Deep sedation] can be a backdoor route to euthanasia if it is used unethically," he said. "The issue is intention. The intention must be the alleviation of pain and suffering. Even a long-term sedation can be ethical as long as the person is not being dehydrated to death. A good palliative care physician won't use the technique very often."
Last year, Dutch researchers found that the use of continuous deep sedation until death was becoming more widespread in the Netherlands where direct euthanasia is already legal. In 2001, researchers found that in six European countries deep sedation was used in 8.5 percent of all deaths in patients with cancer and other diseases.
"The increased use of continuous deep sedation for patients nearing death in the Netherlands suggests that this practice is increasingly considered as part of regular medical practice," said lead researcher Judith Rietjens, a postdoctoral researcher in the Department of Public Health at Erasmus University Medical Center in Rotterdam.
"Also, the use of continuous deep sedation may in some situations be a relevant alternative to the use of euthanasia for patients," Rietjens said.
Deep sedation is associated now with approximately 10 percent of all deaths in the Netherlands, an increase that coincided with an increase in public disquiet about the numbers of active euthanasia cases - numbers that have since declined.
Schadenberg said that the answer to the puzzle is simple: "The statistics of active euthanasia have gone down in the Netherlands because they are simply resorting to deep sedation instead.
"But in fact this simply means that patients are being euthanised slowly in conjunction with the withdrawal of fluids. It is why this is being called 'slow euthanasia'. A lethal injection is quicker, but in fact the ethics are no different. Both intend death."
Judith Rietjens confirmed this, saying, "We can see in our study that those sub-groups where we saw an increase of continuous deep sedation - just in those sub-groups - we saw a lowering of the frequency of euthanasia."