The definition of “palliative sedation” proposed by Bert Broeckaert and Juan Manuel Nunez Olarte, explains very well the specific goal of such treatment: “The deliberate administration of sedative drug in dosages and combinations required to reduce the conscience of a patient in the terminal phase so as to deal properly with one or more refractory symptoms”. In this definition, that does not say everything on some very complex issues on ethical grounds, we find however the element that clearly carefully distinguishes sedation from euthanasia: the criterion of therapeutic proportionality.
There are in fact no clinical reasons to kill a patient or to accelerate the death, while might be appropriate an intervention that in spite of complexities and serious adverse effects (in the specific case, for example, the waiver of the conscience or the possible anticipation of death), is however consistent (and needed), at clinical level, to achieve a certain goal of therapeutic type not otherwise obtainable.
The objective of a really palliative sedation is therefore to respond in a proportionate manner to the discomfort (distress) procured by one or more symptoms that are not otherwise treatable. In the recommendations for the guidelines to sedation, elaborated by the European Association for Palliative Care (EAPC) in 2009, much attention is dedicated to the indications for the treatment, identified in that state of intolerable distress experienced by the patient due to physical symptoms (including dyspnoea, severe pain, convulsions, haemorrhages, asphyxia), where other palliative options proved to be inadequate.
It is evident that a similar indication presupposes that a palliative sedation is characterized by the intention (of the patient, that request it or agrees with it, and of the medical staff who proposes it and implements it) to alleviate suffering not otherwise treatable and, at the same time, by the implementation of a series of measures suitable for the purpose.
Medicine is not a mere execution of the desires or of the will of the patient. Medicine has the task of building – actually, medicine itself ultimately is – a relationship between the doctor (and his team) and the patient (supported by the family) in which there is no doubt that the decisions are taken by listening to the patient and interpreting his needs and aspirations.
Prof. Antonio Gioacchino Spagnolo, Full Professor of Bioethics, Director of the Institute of Bioethics and medical humanities School of Medicine “A. Gemelli”
For further information refer to “Euthanasia texts and commentaries” Libreria Editirice Vaticana