Abstract
This paper is concerned with the moral justification for palliative sedation until death. Palliative sedation involves the intentional lowering of consciousness for the relief of untreatable symptoms. The paper focuses on the moral problems surrounding the intentional lowering of consciousness until death itself, rather than possible adjacent life-shortening effects. Starting from a Kantian perspective on virtue, it is shown that continuous deep sedation until death (CDS) does not conflict with the perfect duty of moral self-preservation because CDS does not destroy capacities for agency. In addition, it is argued that CDS can frustrate the imperfect duty of self-cultivation by reducing consciousness permanently. Nevertheless, there are cases where CDS is morally acceptable, namely, cases where the agent has already permanently lost the possibility for free action in advance of sedation—for example, due to excruciating and ongoing pain. Because the latter can be difficult to diagnose properly, safeguards may be needed in order to prevent the application of CDS for the wrong reasons.
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Notes
It has been discussed whether suicide can be undertaken from other motives than self-love—for example, in order to avoid the further degradation of humanity. But because palliative sedation is by definition applied for symptom relief (a motive of self-love), this issue will not be further pursued in this article.
For a more detailed discussion, see [10, p. 120].
For example, in some cases, this loss of communication skills is due to opioid-induced confusion and agitation which can be reduced by changes in medication administration. Applying CDS in these cases would be a moral (and medical) fault.
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Acknowledgments
The author likes to thank Prof. Dr. Duwell, Professor in Bioethics at the University of Utrecht, Prof. Dr. Vissers, Professor in Palliative Care at the Radboud University Medical Center Nijmegen, and Prof. Dr. Van Leeuwen, Professor in Medical Ethics at the Radboud University Medical Center Nijmegen for their comments on a draft version of the paper.
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Hasselaar, J.G.J. Palliative sedation until death: an approach from Kant’s ethics of virtue. Theor Med Bioeth 29, 387–396 (2008). https://doi.org/10.1007/s11017-008-9088-7
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DOI: https://doi.org/10.1007/s11017-008-9088-7