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Continuous Sedation at the End of Life
Ethical, Clinical and Legal Perspectives


Part of Cambridge Bioethics and Law

Sigrid Sterckx, Kasper Raus, Freddy Mortier, Sophie Bruinsma, Judith Rietjens, Agnes van der Heide, David Albert Jones, Josep Porta-Sales, Nigel Sykes, Eleanor Wilson, Jane Seymour, David Orentlicher, Evelien Delbeke, Johan Legemaate, Richard Huxtable, Ruth Horn, Timothy Holahan, Thomas Carroll, Claudia Gonzalez, Timothy Quill, Johannes van Delden, Søren Holm, Margaret Battin
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  • Date Published: December 2016
  • availability: Available
  • format: Paperback
  • isbn: 9781316618639

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About the Authors
  • Continuous sedation until death (sometimes referred to as terminal sedation or palliative sedation) is an increasingly common practice in end-of-life care. However, it raises numerous medical, ethical, emotional and legal concerns, such as the reducing or removing of consciousness (and thus potentially causing 'subjective death'), the withholding of artificial nutrition and hydration, the proportionality of the sedation to the symptoms, its adequacy in actually relieving symptoms rather than simply giving onlookers the impression that the patient is undergoing a painless 'natural' death, and the perception that it may be functionally equivalent to euthanasia. This book brings together contributions from clinicians, ethicists, lawyers and social scientists, and discusses guidelines as well as clinical, emotional and legal aspects of the practice. The chapters shine a critical spotlight on areas of concern and on the validity of the justifications given for the practice, including in particular the doctrine of double effect.

    • Brings together the views of clinicians, nurses, ethicists, lawyers and social scientists, thereby helping readers understand the controversial aspects of continuous sedation from a range of viewpoints
    • Describes the factors to be considered when continuous sedation is being contemplated and performed, thus enabling the reader to grasp what is involved in the practice
    • Analyses the justifications that are advanced for continuous sedation and explains how clinical, legal, ethical and emotional concerns regarding sedation may be effectively addressed rather than 'papered over'
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    Reviews & endorsements

    'Continuous Sedation at the End of Life offers a thorough and thoughtful analysis of a complex and vexing issue. It successfully spans disciplines and jurisdictions as it provides clinical and epidemiological evidence about - and legal and ethical analyses of - a practice that is in real need of careful attention. By helping us to see that continuous sedation at the end of life needs to be (and how it can be) better understood, monitored, and regulated, this book has the potential to meaningfully contribute to the improvement of care of the dying across the globe.' Jocelyn Downie, Dalhousie University, Nova Scotia

    'This book is clearly a treat to read and digest. As any clinician in palliative care knows, palliative sedation at the end of life is complex. It requires careful communication within the clinical team and, of course, with patients and families. This text mentors the reader to be mindful of all aspects of palliative sedation from the practical aspects, to the ethical dilemmas and the legal frameworks. It explores the challenges faced every day in attempting to meet patients' and families' needs near the end of life. A must-read for all professionals working in or researching palliative care.' Sheila Payne, President, European Association for Palliative Care

    'This thoughtful volume assembles the reflections of leading ethicists, physicians, social researchers and others on the important topic of sedation in end of life care. Of growing importance in the toolkit available for the relief of suffering in the palliative care of dying patients, the relatively new technology of sedation raises many ethical issues which the authors outline in insightful, often original and always informative ways. The combining of perspectives from clinicians and academics is particularly valuable and the editorial introduction provides a masterful summary of the issues involved. This book is destined to be a classic contribution to clinical ethics.' Clive Seale, Brunel University

    'For anyone who wants an in-depth, comprehensive and balanced understanding of the clinical and ethical issues surrounding continuous sedation at the end of life, this book is the place to go. The subject is more complex than most people realize and the authors' contributions are extremely helpful in teasing apart and identifying the critical issues.' Stuart Youngner, Case Western Reserve University, Ohio

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    Product details

    • Date Published: December 2016
    • format: Paperback
    • isbn: 9781316618639
    • length: 306 pages
    • dimensions: 230 x 153 x 17 mm
    • weight: 0.44kg
    • contains: 16 b/w illus. 6 tables
    • availability: Available
  • Table of Contents

    1. Introduction Sigrid Sterckx, Kasper Raus and Freddy Mortier
    2. Continuous sedation until death: state of the art Sophie Bruinsma, Judith Rietjens and Agnes van der Heide
    3. Death by equivocation: a manifold definition of terminal sedation David Albert Jones
    4. Palliative sedation: clinical, pharmacological and practical aspects Josep Porta-Sales
    5. Clinical aspects of palliative sedation Nigel Sykes
    6. Understanding the role of nurses in the management of symptoms and distress in the last days of life Eleanor Wilson and Jane Seymour
    7. Principle and practice for palliative sedation: gaps between the two David Orentlicher
    8. The legal permissibility of continuous deep sedation at the end of life: a comparison of laws and a proposal Evelien Delbeke
    9. The Dutch national guideline on palliative sedation Johan Legemaate
    10. Continuous deep sedation at the end of life: balancing benefits and harms in England, Germany and France Richard Huxtable and Ruth Horn
    11. Can the doctrine of double effect justify continuous deep sedation at the end of life? Kasper Raus, Sigrid Sterckx and Freddy Mortier
    12. Palliative sedation, consciousness and personhood Timothy Holahan, Thomas Carroll, Claudia Gonzalez and Timothy Quill
    13. The ethical evaluation of continuous sedation at the end of life Johannes van Delden
    14. Terminal sedation and euthanasia – the virtue in calling a spade what it is Søren Holm
    15. Terminal sedation: recasting a metaphor as the ars moriendi changes Margaret Battin.

  • Editors

    Sigrid Sterckx, Universiteit Gent, Belgium
    Sigrid Sterckx is a Professor of Ethics at Ghent University and at the Vrije Universiteit Brussel (VUB) in Belgium.

    Kasper Raus, Universiteit Gent, Belgium
    Kasper Raus is a postdoctoral researcher at Ghent University, Belgium.

    Freddy Mortier, Universiteit Gent, Belgium
    Freddy Mortier is a Professor of Ethics at Ghent University, Belgium.


    Sigrid Sterckx, Kasper Raus, Freddy Mortier, Sophie Bruinsma, Judith Rietjens, Agnes van der Heide, David Albert Jones, Josep Porta-Sales, Nigel Sykes, Eleanor Wilson, Jane Seymour, David Orentlicher, Evelien Delbeke, Johan Legemaate, Richard Huxtable, Ruth Horn, Timothy Holahan, Thomas Carroll, Claudia Gonzalez, Timothy Quill, Johannes van Delden, Søren Holm, Margaret Battin

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