Dying while intentionally deeply sedated: how can we ethically justify continuous deep palliative sedation?

Abstract

Recent legislative efforts in Italy regarding end-of-life care have sought to extend the option of continuous deep palliative sedation to patients who do not have a terminal illness. Such developments call for further ethical reflection. This article emphasizes that recourse to continuous deep palliative sedation is ethically permissible and indeed an integral part of palliative care only when it comports with professional guidelines. We argue that ‘imminence of death’, generally understood as death anticipated within hours-to-days, is an important clinical criterion for determining the moral permissibility of the practice. In our discussion, we will (1) explain why the Doctrine of Double Effect, frequently referenced in these debates, does not necessarily apply; (2) identify an alternative clinical and ethical justification for recourse to end-of-life sedation; and (3) discuss the eventual permissibility of recourse to palliative sedation for existential suffering. In so doing, we aim to inform current bioethical debates.