Tuesday, 5 June 2012

Liverpool Care Pathway – A Baptist View

Here is a post on pro-lifepastors’ corner -

MONDAY, MAY 21, 2012

Palliative Sedation Not = To Terminal Sedation/Euthanasia

Wesley J. Smith: The pro-euthanasia crowd intentionally and wrongfully conflates palliative sedation– that is sedating a dying patient at the end of life who is experiencing intractable pain or symptoms –with both euthanasia – fast killing the patient – and terminal sedation – slow killing the patient by inducing coma and withdrawing food and water. A good piece in the Journal of Pain & Palliative Care Pharmacotherapy (201 2;26:30-39) shatters that lie. First, it notes that in palliative sedation, the point is to use the least amount of sedative to accomplish the needed palliation. From “Review of Palliative Sedation and Its Distinction From Euthanasia and Lethal Injection:”
Ideally, the level of palliative sedation is provided in a fashion that is titrated to a minimal level that permits the patient to tolerate unbearable symptoms, yet the patient can continue to periodically communicate…The three most common levels of providing PS include mild, intermediate, and deep. When mild sedation is used, the patient is awake and the level of consciousness is lowered to a somnolent state, with verbal or nonverbal communication still possible. With intermediate sedation, the patient is asleep or stuporous and can still be awakened to communicate briefly. The third level is deep sedation, which refers to the patient being near or in complete unconsciousness and does not communicate verbally or nonverbally. Besides regulating the degree of sedation, palliative sedation may also be provided intermittently or continuously…
The points to take away from the above are 1) palliative sedation is individualized to the patient’s needs, 2) the point isn’t to end the life of the patient, and 3) levels of sedation may vary in the same patient from time to time. In contrast, euthanasia kills the patientwith a lethal injection. And “terminal sedation” is merely the imposition of coma and withdrawing artificial nutrition and hydration, sometimes without actual medical need and/or to make it easier for care givers–as in the much abused Liverpool Care Pathway in the UK.

The abstract of the article cited above reads:

Review of Palliative Sedation and its Distinction From Euthanasia and Lethal Injection

2012, Vol. 26, No. 1 , Pages 30-39 (doi:10.3109/15360288.2011.650353)


Palliative sedation evolved from within the practice of palliative medicine and has become adopted by other areas of medicine, such as within intensive care practice. Clinician's usually come across this practice for dying patients who are foregoing or having life support terminated. A number of intolerable and intractable symptom burdens can occur during the end of life period that may require the use of palliative sedation. Furthermore, when patients receive palliative sedation, the continued use of hydration and nutrition becomes an issue of consideration and there are contentious bioethical issues involved in using or withholding these life-sustaining provisions. A general understanding of biomedical ethics helps prevent abuse in the practice of palliative sedation. Various sedative drugs can be employed in the provision of palliative sedation that can produce any desired effect, from light sedation to complete unconsciousness. Although there are some similarities in the pharmacotherapy of palliative sedation, euthanasia, physician-assisted suicide, and lethal injection, there is a difference in how the drugs are administered with each practice. There are some published guidelines about how palliative sedation should be practiced, but currently there is not any universally accepted standard of practice.


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