Continuous Sedation Until Death Should Not Be an Option of First Resort

Samuel H. LiPuma and Joseph P. DeMarco argue for a positive right to continuous sedation until death (CSD) for any patient with a life expectancy less than six months. They reject any requirement of proportionality. Their proposed guideline makes CSD an option for a decisional adult patient with an appropriate terminal diagnosis regardless of whether suffering (physical or existential) is present. This guideline purports to "empower" the patient with the ability to control the timing and manner of her death. This extends even to the option to "opt out" of the awareness and experience of dying and to avoid suffering altogether, even if one's symptoms and suffering could be effectively treated. We respond first with a critique of their terminology. We then turn to some purely practical considerations of how this guideline might be enacted in the current atmosphere of American hospice and palliative care medicine. We close with a consideration of one philosophical concern that might ground the discussion of risks, benefits, and alternatives necessary for informed consent.