terminal sedation

[Guest mydream88]

hello,

I was just gathering some information from a neurology textbook and I came across a new term that I was wondering what my favourite medical-like folk think of:

 

terminal sedation. The textbook indicated that it entails sedating a terminally ill patient to unconsciousness whereby the patient eventually succumbs to their disease or dehydration.

 

Is this legal in canada? I am asking because I was quite shocked to hear of such a treatment option. I would love if anyone could share their thoughts and opinions on this type of medical treatment.

 

happy friday,

mydream88:\

[Guest QM6]

Hey mydream88,

 

Since euthanasia and assisted suicide are still illegal in Canada, "terminal sedation" as you've strictly defined it with the intent to cause death wouldn't fly with regulatory authorities...

 

... but in our Ethics class we did discuss cases where the terminal patient's in increasing, unbearable, acute pain, and so increasing sedation/analgesics are given in response to the pain to keep the patient as comfortably pain-free as possible. Of course, eventually there's a point where these levels of drugs reach lethal levels, and the physicians know this but continue anyway, as the intent throughout is to kill the pain, not the patient.

 

It's argued that, in these cases, while the sedation might have brought death on sooner, it was ultimately the painful, terminal phase of disease course that took the patient. This contrasts with another terminally-ill patient, say someone with ALS, who isn't yet at an acute stage of the disease and could still have months-years of life - you couldn't pull the "terminal sedation" card in this instance.

 

So yeah, I guess I would have to add on to that definition something about the sedation being in response to pain etc; otherwise, if there's no other medical reason to provide the sedative in such lethal amounts, that's probably no longer medical treatment - that's criminal treatment.

[Guest UWOMED2005]

I'm not shocked by that concept at all.

 

We routinely stop checking the electrolytes on patients who switch to palliative care, as per their and their family's wishes. After all, why keep causing the patients discomfort by poking them with needles in this situation? In a couple of cancer patients in this situation, their potassium had been gradually creeping up for weeks: when we caught this by checking the lytes, we corrected it, every few days.

 

In both cases, as soon as I was ordered to stop checking lytes, I'm sure the potassium got to a very high level within days. In fact, I'd be surprised if it wasn't the potassium that killed the patients in the immediate future.

 

Now technically we're not administering the potassium in this case so it's not doctor assisted suicide or ethanasia. But both patients might have lived a little while longer (ie a couple of days) had we kept doing what we routinely do on many/most hospitalized patients.

 

If you're really interested in medicine, I'd suggest you get your feelings sorted out about this issue before clerkship. Because it crops up more often than you're probably aware.