Conflict of interest statement: No conflicts declared
NARRATIVES OF ‘TERMINAL SEDATION’, AND THE IMPORTANCE OF THE INTENTION-FORESIGHT DISTINCTION IN PALLIATIVE CARE PRACTICE
Version of Record online: 4 JUL 2011
© 2011 Blackwell Publishing Ltd.
Volume 27, Issue 1, pages 1–11, January 2013
How to Cite
DOUGLAS, C. D., KERRIDGE, I. H. and ANKENY, R. A. (2013), NARRATIVES OF ‘TERMINAL SEDATION’, AND THE IMPORTANCE OF THE INTENTION-FORESIGHT DISTINCTION IN PALLIATIVE CARE PRACTICE. Bioethics, 27: 1–11. doi: 10.1111/j.1467-8519.2011.01895.x
- Issue online: 6 DEC 2012
- Version of Record online: 4 JUL 2011
- hypnotics and sedatives;
- terminal care;
- double effect;
- qualitative research;
The moral importance of the ‘intention–foresight’ distinction has long been a matter of philosophical controversy, particularly in the context of end-of-life care. Previous empirical research in Australia has suggested that general physicians and surgeons may use analgesic or sedative infusions with ambiguous intentions, their actions sometimes approximating ‘slow euthanasia’. In this paper, we report findings from a qualitative study of 18 Australian palliative care medical specialists, using in-depth interviews to address the use of sedation at the end of life. The majority of subjects were agnostic or atheistic. In contrast to their colleagues in acute medical practice, these Australian palliative care specialists were almost unanimously committed to distinguishing their actions from euthanasia. This commitment appeared to arise principally from the need to maintain a clear professional role, and not obviously from an ideological opposition to euthanasia. While some respondents acknowledged that there are difficult cases that require considered reflection upon one's intention, and where there may be some ‘mental gymnastics,’ the nearly unanimous view was that it is important, even in these difficult cases, to cultivate an intention that focuses exclusively on the relief of symptoms. We present four narratives of ‘terminal’ sedation – cases where sedation was administered in significant doses just before death, and may well have hastened death. Considerable ambiguities of intention were evident in some instances, but the discussion around these clearly exceptional cases illustrates the importance of intention to palliative care specialists in maintaining their professional roles.