Options of Last Resort: Palliative Sedation, Physician Aid in Dying, and Voluntary Cessation of Eating and Drinking.

Document Type

Article

Publication Date

5-1-2020

Publication Title

The Medical clinics of North America

Keywords

Aged; Aged, 80 and over; Communication; Decision Making; Deep Sedation; Drinking Behavior; Euthanasia, Active, Voluntary; Feeding Behavior; Humans; Nurses; Palliative Care; Physicians; Suicide, Assisted; United States

Abstract

Some patients with terminal and degenerative illnesses request assistance to hasten death when suffering is refractory to palliative care, or they strongly desire to maximize their autonomy and dignity and minimize suffering. Palliative sedation (PS), voluntarily stopping eating and drinking (VSED), and physician-assisted death (PAD) are possible options of last resort. A decision to choose PS can be made by an informed surrogate decision maker, whereas intact decision-making capacity is required to choose VSED or PAD. For all palliative treatments of last resort, the risk of harm is minimized by the use of checklists, and establishment of policies and procedures.

Department

Palliative Care

Department

Biomedical Ethics

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