Bravo to The New York Times for its in-depth reporting on palliative sedation. When death is imminent, sedating a patient if nothing else can be done to ameliorate severe suffering is a legitimate medical intervention. Those who confuse palliative sedation with euthanasia either out of ignorance or with intent to blur crucial distinctions for political reasons do suffering patients a profound disservice. Since any medical intervention can have unintended lethal side effects, we should no more consider palliative sedation euthanasia than when a patient dies during heart bypass surgery. Indeed, it would be a terrible thing if patients in need refused or were denied this humane medical treatment because they or their physicians mistakenly confused it with mercy killing.
Some of the other letters brought up important points. A hospice physician notes that other palliative techniques can result in a sedation effect, to which I add, so do disease processes. He then makes an important point that Dr. Eric Chevlen and I also noted in our book, Power Over Pain: How To Get the Pain Control You Need:
Second, the article perpetuates the myth that death is hastened by pain relievers and sedatives in these circumstances. Sufficient research exists to contradict these concerns and suggests that far from hastening death, such interventions appear to have a neutral effect on survival and may actually prolong life while relieving suffering. How so? A patient with uncontrolled pain is under severe cardiovascular stress from the pain itself. A rapid heart rate, shallow breathing and agitation will themselves shorten life as death nears. Relief of the pain calms the heart and helps the patient breathe more effectively.
A hospice nurse correctly points out that PS is a rarely needed last resort:
Too often, palliative sedation is used as a first-line therapy rather than a therapy of last resort. In some units, palliative sedation is used on one-third to one-half of patients. That is far too often. Most expert providers will use palliative sedation extremely rarely in a 20- to 25-year career. Further, expert providers do not use palliative sedation lightly. They consult with colleagues to make sure that all other means of symptom management have been tried.
And assisted suicide advocate Barbara Coombs Lee, ever obsessed with the Catholic Church, brings up religion and contends that there is no difference with mercy killing, which she euphemistically refers to as easing dying:
Candid and thorough, your report on terminal sedation demonstrates the problem when the legal status of a medical procedure rests on whether a doctor’s primary thought and intention is to treat suffering (legal) or ease dying (illegal). The arcane [Catholic] theological doctrine of double effect creates a thought crime and ignores the patient’s wishes altogether. Terminal sedation treats suffering and eases dying. We should learn to acknowledge and honor both effects.
Lee is a lawyer. She knows intent is a crucial issue in determining whether a crime has been committed. Her letter illustrates an important point about her advocacy: Always remember that in her deepest heart, Lee is an assisted suicide ideologue who will use every means at her disposal to conflate proper medical care with killing. In this regard, it is worth noting that her group was behind AB 2747 that, had it passed as originally written, would have redefined palliative sedation to death on demand by induced coma and dehydration, for patient with a year or less to live and without regard to symptoms or suffering not otherwise capable of being relieved.