on tHe licitness oF inducing palliative sedation andremoval oF artiFicial nutrition and Hydration at tHeend-oF-liFe

Abstract

The question of whether palliative sedation to unconsciousness and removal ofnutrition and hydration (ANH) at the end of life has recently been raised. This hasalso brought about a controversy of the liverpool care Pathway, practiced in theUK at the End-of-life, which aimed to bring about the widely acceptedbiopsychosocial approach used in Hospice settings to the hospital. It is arguedthat the licitness of existential suffering in the context of a patient alreadysedated, a situation which can render persons vulnerable to their own feelings,must be considered. The fact that ANH is not always given in the context ofprimary (home) care questions whether this can licitly be imposed in a hospitalsetting, and, moreover, whereas a different standard of care may be licit in theformer setting when palliative relief is given leads us also to question howstringent we should be when people are in a secondary setting when it comes toincreasing doses leading to sedation. In this context a case is made that one canlegitimately invoke the doctrine of double effect in which the good is not broughtabout by a deliberate induction of the harm (sedation and removal of ANH) oncethis is arrived to consequentially and prudently. A discussion of the religiousdimension (and concerns) on the health care – patient relationship in the light ofrecent developments in Trinitarian ontology as applied to social settings is alsointroduced.