BMJ Support Palliat Care 3:203-206 doi:10.1136/bmjspcare-2012-000431
  • Feature

Moral differences in deep continuous palliative sedation and euthanasia

  1. Gert Helgesson
  1. Stockholm Centre for Healthcare Ethics, Karolinska Institutet, LIME, Stockholm, Sweden
  1. Correspondence to Niklas Juth, Stockholm Centre for Healthcare Ethics, LIME, Karolinska Institutet, Stockholm 171 77, Sweden; niklas.juth{at}


In palliative care there is much debate about which end of life treatment strategies are legitimate and which are not. Some writers argue that there is an important moral dividing-line between palliative sedation and euthanasia, making the first acceptable and the latter not. We have questioned this. In a recent article, Lars Johan Materstvedt has argued that we are wrong on two accounts: first, that we fail to account properly for the moral difference between continuous deep palliative sedation at the end of life and euthanasia, and, second, that we fail to account properly for the difference between permanent loss of consciousness and death. Regarding the first objection, we argue that Materstvedt misses the point: we agree that there is a difference in terms of intentions between continuous deep palliative sedation and euthanasia, but we question whether this conceptual difference makes up for a moral difference. Materstvedt fails to show that it does. Regarding the second objection, we argue that if nothing else is at stake than the value of the patient's life, permanent unconsciousness and death are morally indifferent.

  • Received 6 December 2012.
  • Accepted 8 February 2013.
  • Published Online First 6 March 2013

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