“Terminal sedation” refers to the use of sedation as palliation in dying patients with a terminal diagnosis. Although terminal sedation has received widespread legal and ethical justification, the practice remains ethically contentious, particularly as some hold that it foreseeably hastens death. It has been proposed that empirical studies show that terminal sedation does not hasten death, or that even if it may hasten death it does not do so in a foreseeable way. Nonetheless, it is clear that providing terminal sedation (...) in combination with the withholding or withdrawing of life-prolonging treatments such as fluid and nutrition can foreseeably hasten death significantly—what is here called early terminal sedation . There are ethical justifications for the use of sedation in palliative care and thus it would seem that ETS is an ethically and legally acceptable practice. However, what emerges from the literature is the repeated assertion that terminal sedation must be restricted to use in imminently dying patients—the “imminence condition”—and that therefore ETS is unacceptable. This restriction has taken on greater significance with the trend of palliative care to include the care of patients who are not imminently dying. This paper proposes to show that although there is widespread intuitive support for the imminence condition, it does not follow from the justifications for sedation as palliation, and that explicit arguments for the imminence condition are needed. (shrink)

ABSTRACT There has been much discussion regarding the acceptable use of sedation for palliation. A particularly contentious practice concerns deep, continuous sedation given to patients who are not imminently dying and given without provision of hydration or nutrition, with the end result that death is hastened. This has been called ‘early terminal sedation’. Early terminal sedation is a practice composed of two legally and ethically accepted treatment options. Under certain conditions, patients have the right to reject hydration and nutrition, even (...) if these are life‐sustaining. Patients are also entitled to sedation as palliation for intolerable, intractable suffering. Though early terminal sedation is thought to be rare at present, the changing nature of palliative medicine suggests its use will increase. Arguments regarding early terminal sedation have failed to recognize early terminal sedation as a distinct legal and ethical entity. It can be seen as both the simple sum of treatment refusal and sedation for palliation, analogous to terminal sedation. It can also be seen as an indivisible palliative treatment, more analogous to assisted suicide or euthanasia. But ultimately, it is wholly analogous neither to terminal sedation given when death is imminent, nor to assisted suicide or euthanasia. This paper contends that early terminal sedation should be considered as a distinct entity. Such a reconception promises to provide a way forward in the debate, practice and policy regarding this contentious area of palliative medicine. (shrink)

To the Editor: It was with great interest that our Canadian Palliative Sedation Therapy Guideline working group read Jeffrey Berger's recent article ("Rethinking Guidelines for the Use of Palliative Sedation," May-June 2010). Given our own group's efforts to develop national guidelines, we have rethought the issue of palliative sedation therapy several times over the past year.The use of clear and concise definitions is fundamental to the development of any consensus guidelines on this topic. In the article, the term "palliative sedation (...) to unconsciousness," or PSU, implies the concerning assumption that sedation will knowingly be to unconsciousness in the palliative case under consideration. This conflicts with .. (shrink)

В книге изложены понятия, структуры, функции, основные типы юридического сознания, культуры и антикультуры в обществе. Особое внимание уделено психологическому механизму деятельности, мерам юридической ответственности и правовой защиты людей, их коллективов и организаций. Для юристов (ученых и практиков, аспирантов и адъюнктов), студентов магистратуры и бакалавриата юридических вузов и факультетов. Монография выполнена при финансовой поддержке РФФИ в рамках научного проекта № 18-011-01095.

Russkai︠a︡ t︠erkovʹ i drugie statʹi -- V temnykh religioznykh luchakh.

Издание предназначено для студентов и преподавателей гуманитарных образовательных учреждений, специалистов и практиков в различных областях науки.

Vor-Worte.--Religion und Psychologie.--Not und Hilfe.--Der Liebe in der Aufbauordnung des Stifterschen Menschenbildes.--De profundis ; eine Auseinandersetzung mit C.G. Jung, Herbst 1945.--Christentum und Humanismus ; ein Gespräch mit Erziehern.