The Ethical Dilemma of Continuous Sedation until Death (Research Paper Sample)

The Ethical Dilemma of Continuous Sedation until Death (CSD)
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Institution:
Palliative Sedation
In their study "Descriptions by General Practitioners…” (p. 535) Rys et al. report that sedating a patient who is terminally ill thus relieving their distress has been deployed in end-of-life care for a considerable period. The sedation can be deployed intermittently for short periods or continuously until death. Anquinet reports that CSD gains more fame in medical practice, with research in countries such as Netherlands and Belgium indicate increasing usage. Most of the physicians indicated that they deployed CSD with a (co)intention to speed up death. In this case, there lacks informed consent in which patients are not notified of the approach whereas it has also been deployed in other cases where better alternatives would have controlled suffering.
To provide good CSD practice, several position statements or guidelines on the intervention are published as indicated by Raus, Sigrid and Freddy. Through formulation of recommendations, the guidelines describe several circumstances in which CSD can be termed as morally justified. For instance, this may include an emphasis on the palliative intention when defining CSD. Guidelines result from top-down and well thought-out processes through which ethicists, physicians, lawyers and other experts are involved.
The Argument
In reference to North "Greek Medicine...” continuous sedation until death is defined as the act of removing the consciousness of an ill patient until death due to little chances of survival. The topic has induced wide discussions focused on ethical concerns surrounding it. In their study, the opinions expressed in medical and nursing literature are analyzed to examine how clinicians defined CSD as well as how they justified the act. Palliative sedation and terminal sedation are deployed to describe continuous sedation until death (CSD). Raho and Miccinesi in "Contesting the Equivalency …” report that the debate concerning CSD in nursing and medical journals lacked uniform definition and terms whereby the debate is characterized by charged language. The definitions of terms and justifications for CSD call for further clarifications.
Despite the established guidelines, continuous sedation until death still remains subject to legal, clinical and ethical debate. While others contest between the difference between the approach and euthanasia, others report that despite CSD not causing death in some cases, it results in loss of the patient’s capacity to communicate (Swart et al.). As per North Hippocratic Oath, one of the guidelines is to apply for the benefit of the patient through all the necessary measures required to avoid therapeutic nihilism and twin traps of overtreatment (North).
While in modern world medicine is used to solve most problems, the line between helping and over treating is not defined. CSD is seen as a permanent event in which after sedation, patients can no longer change their mind and regrets cues in the subjects cannot be noticed (Seymour). On the other hand, CSD is seen as an approach that honors the autonomy of patients in which patients who have analyzed their options and opted for CSD are served to their terms. CSD is also seen as an easier way through which relatives and friends can completely accept the passing of their loved one (Seymour et al.).
Singapore is depicted to be using CSD and defining it as a monitored application of treating all forms of physical and emotional pain and suffering through terminal sedation. Another argument against CSD indicates that the use of anesthesia and sedatives reduce the lifespan of the patients. Rhahda in “Addressing the Concerns…” (p.6) counters this argument by stating that opioids, sedatives and nutrition offered to patients during the intervention have little influence on the patient’s prognosis especially when provided in the last weeks of life. Other commentators and guidelines, however, believe that there is a clear difference between euthanasia and CSD. Distinguishing the two acts as one of the main reasons of the Dutch national guideline on sedation that serves as the basis for building other sedation guidelines (Rys et al.).
Emotional and Physical Closeness
Respondents report that their involvement in continuously sedating patients until death affected them in a greater impact and it depended on the degree of which the felt physically and emotionally close to the particular individual receiving CSD (Dutcharme and Robert). Relatives of the patient as expected are involved more emotionally than physicians who are not involved in the routine care of the patient. Emotional closeness is reported as greatest when the caregiver identified with the patient or developed a personal bond. Respondents are also recorded to reduce the emotional closeness through emphasizing the need to be professional as campaigned for by several nurses and physicians. Physical closeness is seen to influence the emotional impact that affected most relatives and nurses who provided the majority of the physical care (Rys et al.).
Some care providers argued that being physically close to a sedated patient increased their ability to cope when CSD was administered successfully to make the patient comfortable. However, when patients were deemed as suffering, being close to them physically was distressing as indicated by Raho and Miccinesi in "Contesting the Equivalency…”. Decisional closeness involves making hard decisions on a person’s life that may have traumatizing effects on the physicians, relatives and nurses involved. There exist major differences concerning decisional authority between nurses, physicians and relatives whereby nurses feel they lack the responsibility for the choices made. Nurses, as a result, see their role to be advisory hence reducing their decisional closeness. In some cases, relatives are also reported to experience a lesser role in the process of making decisions on CSD (Rys et al.).
While others argue of the decisional authority lying on the medical team and the physician, others feel that the patient has the ultimate decision on their life. Decisional closeness for the person is reduced through depicting the decision as a group decision in that the responsibility was shared. In this case, all stakeholders involved in the case contribute to making a collaborative decision. Other means are also used such as emphasizing that CSD was the most applicable approach to benefit the ill patient and their relatives at that point. In this case, the situation is neutralized with some inevitability where following the medical history and physiological state, CSD was the only sensible option available. The decisional closeness is also reduced through the medical personnel indicating that they were simply following the ethical guidelines (Seymour).
Arguments are also emphasized on the intention that is seen as the difference between a CSD death and others from euthanasia. In euthanasia, a more deliberate action is believed to be behind the individual’s death while, in this case, life shortening is viewed as a side effect thus making it less casually close. Other respondents indicate that CSD does not reduce life but is only involved in reducing the causal closeness through asserting their actions did not contribute directly to the death of the patient (Seymour). In the study conducted by Anquinet et al. to interview nurses and multiple general practitioners on their experiences in dealing with CSD patients, one of the respondents is indicated as saying that she experienced an emotional burden due to the uncertainty surrounding whether the approach was indeed hastening the patient’s death.
When carrying out terminal sedation, the physician prescribes medications to the patients which are administered by nurses who also make decisions on time and quantity. Another dilemma arises where there are major doubts when administering medication to critically ill patients and nurses sometimes have no idea on whether the sedation would kill their patient or not. However, they are left to do whatever they thought ideal thus summarizing the type of battles faced by nurses in Palliative sedation.
Stressing Benefits over Harms
Despite the physical and emotional closeness of a healthcare provider to the patient, the overall goal is to meet the health demands of the patient. As a result, they are expected to deal with the heavy burden of responsibility to observe optimal benefits for the patients. With the perception that CSD did ease the moral and emotional distress, medical practitioners opt to carry out the approach with the goal of positive outcomes offering remedies for emotional and moral distress (Raho and Miccinesi). To reduce the effect of causal closeness, health care providers embark on stressing the benefits attained through dealing with this form of closeness. The presence of a wiggle room in CSD influenced the manner in which care providers influenced decisional, emotional and causal closeness. Despite the a...