Palliative care and the right to avoid suffering: patterns of care for the sake of the terminally ill

Deep sedation can only be administered for the purpose of countering otherwise intractable symptoms, and requires the informed consent from patients or their legal guardians or health care proxy holders. The patient’s illness needs to be at a terminal stage, or even, according to some, near death. In light of deep sedation’s main goal, which is to preserve the patient’s dignity, it is in our view excessive to limit it to those cases where death is near. There other tools that go a long way in avoiding an overuse of such techniques. First and foremost, it is necessary that such choices are always made in a proportionate and gradual fashion: deep and constant se dation should only be considered when becoming unconscious would be the “lesser evil”, that is when the pain is so unbearable that it makes it impossible for the patient to engage in any normally rewarding kind of activity. Moreover, doctors should be granted the option to refuse to put in place procedures that they deem to be disproportionate, even though the patients require them. In that respect, it is desirable that national legislators outline clearly-defined sets of rules designed to determine the rights of patients and their actual scope.