Sedation in the imminently dying patient

Sedation is a clinically important therapeutic intervention in the imminent ly dying patient. As the patient with an advanced, irreversible illness nea rs the end of life, symptoms accumulate that are progressively more difficu lt to manage and that may become refractory to standard medical interventio ns, The most common of these intractable symptoms are pain, agitated deliri um, dyspnea and existential or psychological distress. Various therapeutic options available for relieving these symptoms include physician-assisted s uicide, euthanasia, acceptance of unrelieved suffering, and terminal sedati on, Some commentators have voiced concerns that sedating the imminently dyi ng patient inevitably hastens death, and that this practice, in fact, is a surrogate form of physician-assisted suicide or euthanasia. Ethical argumen ts invoked to support the use of terminal sedation include the principle of double effect, which draws a moral distinction between the intention of an act(in this case, to relieve suffering) and its foreseen but unintended co nsequence (premature death). This author views sedation as a necessary, alt hough risk-laden, procedure that, if practiced by trained, dedicated clinic ians, maintains the physician's twin obligations to benefit patients and to "do no harm".