Thursday, August 20, 2009

Deep Sedation, Dehydration and Euthanasia

Alex Schadenberg
By Alex Schadenberg
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, "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."


leticia cadelina said...

Your article is very enligthening which reminded me of my brother's passing away in May at Vancouver General Hospital, B.C.
He was paraplegic T4 level since 1971,fully rehabilitated,self sufficient and he lived.1999 his decubitus ulcer(L buttock) was operated on(VY Plasty),infected while in hospital,became MRSA and then his incision dehisced in 2000.He suffered chronic infection and acquired osteomylitis.
In 2007, he was diagnosed with lung cancer,he was operated on,recovered but had recurrence in Jan 2009. Had radiation and the tumor cells shranked.His decubitus ulcer which was operated on again in 2008 and healed well,became infected during a NORO virus outbreak in the extended care.He was up and about until the day the residence were quarantined. There was no replacement therapy for fluid lost for diarrhea.He developed perianal abscess which was not treated properly at the time of initial presentation at VGH. He was sent back to the extended care which he was a resident,he cried and informed us that he was being thrown away and expressed his fear that he was being done away with.The abscess was not drained, gave an antibiotic that he was resistant to and the medical team did their heroics moves the day my brother went to respiratory arrest because he became septic. All they did to us was to talk about quality of life, they talked and watched while my brother was fighting for his life and we his siblings fought for his right to live and the medical team gave a DNR order inspite of the presence of his living will. A delayed treatment , is a denial of care.
This makes me wonder about the rights of people with disability, 65 years old with lung cancer. My brother was in pain but not dying.
I believed that he was euthanized with delayed treatments.

Unknown said...

24th February 2010.
My mother is suffering from Vulval Cancer and is in pain but not dying. On 14 feb 2010, the Hospice put her on a Syringe Driver with Morphine and a Sedative. On the 15feb they dobled the dose and said because she was agitated !!They are also denying her of Fluids and Food. Is this Legal in Ireland ? Please this is urgent. We spoke to the Hospice today and they are not giving us any logical reason for the Fluid denial. They are starving her to death and we cannot do a thing. They told us that they are denying fluids because it may complicate the Respiratory secretions (for which she is on another medicine Robinol). What can we do ???

Anonymous said...

Deep sedation is not effective. You should research your facts first. Why do you think whn=en a patient dies at home they recommend dark sheets and in hospital change sheets constnatly - peopl often beeld and wake up vomittting blood. I have worked in palative care and seen people wake up near the end becasue there is a point when no amount of morphine will work, and they drownd to death in thie flueid in their lungs. This is happening daily in our hsopitals. Your articla has not reference ro facts or truthes. Deep sedation ALWAYS incluide dehydration because you acn't give enough fluid to paitent who is filling up with fluid due to tumors. The fluid building in their abdomine is draining them of sluid alreaedy.
Ig you believe pople are dying peacefully then I suggest you put cameras in all palative care rooms and see the balntant violloation of our right o humaine treatment that occurs daily. Most death certificats tahta say "died peacefully" the person did anything but!

Alex Schadenberg said...

Dear Anonymous:

You obviously have a bias or a purpose to writing this response.

Whether many or some people experience a difficult death or not is one issue. I find it tragic that we are not providing the necessary care to alleviate the suffering for these people.

You are also trying to convince the world that everyone will suffer at death. A good death is possible without legalizing lethal injections.

Nonetheless, my point is clear. To intentionally dehydrate a person, who is not otherwise dying, is euthanasia. When a person is dying, then it is clear that the fluid will not alleviate symptoms but rather may add to the symptoms.

The issue is when a decision is made to intentionally cause death by dehydration of a person who is not other wise dying.