Differences between Palliative Sedation and Euthanasia

euthanasia palliative sedation

Recently a French commission visited The Netherlands. It was a government commission. They were asked to look into the euthanasia legislation in France. They heard about the practice of palliative sedation and they probably think this is a solution for not having to adapt their euthanasia legislation. In France euthanasia is forbidden. That’s why they came to The Netherlands to be informed about palliative sedation.

A few months ago the French high court wouldn’t grand a woman with a facial tumor to have euthanasia. The tumor was deforming and very painful and would kill her in a couple of months.

Palliative sedation is something completely different from euthanasia.

  • Palliative sedation is defined as the intentional lowering of a patient’s level of consciousness. The aim of palliative sedation is to relieve unbearable suffering by means of lowering the level of consciousness. It is not used to shorten life. Often patients suffer extremely in the last stages of life and this could be an indication for palliative sedation.
  • The degree of sedation intended or required may vary from superficial to deep. In the first case the possibility to communicate is retained
  • Palliative sedation may also be applied briefly or intermittently.
  • The definition of palliative sedation does not include situations where: benzodiazepines are administered in normal doses to relieve insomnia and/or anxiety, sedation is an unintended side effect of medication (for example, as a result of the administration of morphine to relieve pain or dyspnoea, sedation is merely employed during a painful or unpleasant medical procedure such as endoscopy
  • Euthanasia is defined as the administration of drugs with the explicit intention to end life at the patient’s request, and it is legally accepted under certain conditions in Dutch law. In 2001, 2.6% of all deaths in the Netherlands were preceded by euthanasia
  • Patients receiving euthanasia were actively involved in the decision-making process. This is true of only slightly more than half of the patients receiving terminal sedation. Terminal sedation is the use of palliative sedation bringing the patient into deep sedation while forgoing artificial nutrition or hydration at the end stages of life

In a recent research published in the Archives of Internal Medicine the researchers compared characteristics of the patients, the decision-making process, and medical care of both euthanasia and palliative sedation

Their conclusion was:

Terminal sedation and euthanasia both are often applied to address severe suffering in terminally ill patients. However, terminal sedation is typically used to address severe physical and psychological suffering in dying patients, whereas perceived loss of dignity during the last phase of life is a major problem for patients requesting euthanasia.

In The Netherlands euthanasia is allowed when strict rules are applied. Between 2001 and 2005 the number of patients after palliative sedation increased with 1800, the number of patients dying with euthanasia decreased in this period with 1200. Terminal sedation is only allowed when death will probably occur within 2 weeks.

This shift might be explained by increasing experience with palliative sedation. In the end palliative sedation will not completely relieve the French from their problems with euthanasia.