Eric L. Krakauer, MD, PhD
Krakauer E.; Responding to Intractable Terminal Suffering. Ann Intern Med. 2000;133:560. doi: 10.7326/0003-4819-133-7-200010030-00020
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Published: Ann Intern Med. 2000;133(7):560.
TO THE EDITOR:
I applaud Quill and Byock's thoughtful discussion of options for responding to intractable terminal suffering (1). However, the term terminal sedation is confusion, misleading, and potentially harmful. First, the term is contradicted by the authors' own discussion of it. They write that terminal sedation, defined as “the use of high doses of sedatives to relieve extremes of physical distress,” “is not restricted to end-of-life care.” If the patient has a prospect of recovery, then the sedation may be used for intractable distress but is not necessarily “terminal.” Second, the term terminal sedation inevitably connotes sedation intended to terminate, or euthanasia (2)—precisely what the authors say it does not mean. According to their description, it is a treatment intended only to relieve suffering by inducing unconsciousness in the rare cases when suffering cannot be relieved by any other means. In keeping with the principle of double effect (3, 4), terminal sedation is not intended to end the patient's life yet may have the foreseeable side effect of hastening death. Because of the connotation of euthanasia, the term may be upsetting to many patients and clinicians and therefore may hinder discussion and provision of appropriate palliative care.
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