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76 Sedation or Assisted Dying? – An ethical argument
  1. Till Kroeber
  1. Strathcarron Hospice


Introduction Palliative care facing the unbearable, sustained suffering of some terminally ill patients seeks ways to relieve this suffering, while staying within professional ethical boundaries that can change over time. Given that the proposed Assisted Dying for the Terminally Ill Adults (Scotland) Bill is currently going through the Scottish Parliament, it is worth comparing forms of terminal sedation to assisted dying from an ethical perspective.

Argument A procedure that causes less harm while achieving the same benefit is preferable to a treatment that causes greater harm. Certain forms of sedation do not terminate life. Assisted dying terminates life, which can be seen as the ultimate harm.

Both achieve an end to suffering for the patient. Therefore, certain forms of sedation are preferable to assisted dying.

Details Life can be said to have an intrinsic value, and to avoid doing harm is an established ethical principle. Forms of sedation that do not terminate life are late deep continuous sedation, intermittent deep sedation, and proportionate palliative sedation. Only the latter is widely practiced in the UK. Sedation can be said to cause the lesser harm of unconsciousness, compared to the greater harm of death. However, too light sedation is insufficient to relieve suffering whilst too heavy sedation can contribute to the termination of life. To terminate life through assisted dying can be seen as the ultimate violation of the ethical principle to do no harm. Both assisted dying and forms of sedation can be said to relieve subjectively experienced, unbearable suffering.

Conclusion Late deep continuous sedation, intermittent deep sedation, and proportionate palliative sedation respect the intrinsic value of life, thereby avoiding the main ethical objection to assisted dying. It is important to explore, in detail, the role and practicalities of various sedations for palliative patients.

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