Arguments for and against palliative sedation : - an ethical reflection

Abstract: Introduction: Palliative sedation is the use of sedatives to lower the alertness for symptomcontrol, when suffering is otherwise uncontrollable. Its role in palliative care is frequentlyargued, with both proponents and opponents. End-of-life decisions raise many concerns,including ethical ones, regarding which ethical principle should be valued the most. Someopponents argue that palliative sedation is ethically similar to euthanasia, but there alsoappears to be some confusion concerning concepts and definitions. Aim: To discuss ethical arguments for and against palliative sedation, and relevant ethicaldifferences between palliative sedation and euthanasia. Furthermore, to try to clarify differentconcepts and definitions used in the discussion of the matter. Materials and methods: This work is based on a qualitative literature study, and anargumentative- and concept analysis on hermeneutic ground. Material was gathered through aliterature search, and contains official material, debate articles and scientific articles. Results: Palliative sedation can be argued to protect the ethical values of autonomy,beneficence, dignity and integrity, but simultaneously it is argued to violate those ethicalconcepts. There seems to be disagreements regarding which principle should be highestvalued. Conclusion: The matter of palliative sedation is delicate, and engages a lot of people. Pro- andcontra-arguments vary in strength, partly because of an inconsistency in the use of differentconcepts and definitions. In most of the material studied, it is argued that palliative sedation isethically acceptable, whereas euthanasia is not.