On the licitness of inducing palliative sedation and removal of artificial nutrition and hydration at the end-of-life

Abstract

The question of whether palliative sedation to unconsciousness and removal of nutrition and hydration (ANH) at the end of life has recently been raised. This has also brought about a controversy of the Liverpool Care Pathway, practiced in the UK at the End-of-Life, which aimed to bring about the widely accepted biopsychosocial approach used in Hospice settings to the hospital. It is argued that the licitness of existential suffering in the context of a patient already sedated, 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 of primary (home) care questions whether this can licitly be imposed in a hospital setting, and, moreover, whereas a different standard of care may be licit in the former setting when palliative relief is given leads us also to question how stringent we should be when people are in a secondary setting when it comes to increasing doses leading to sedation. In this context a case is made that one can legitimately invoke the doctrine of double effect in which the good is not brought about by a deliberate induction of the harm (sedation and removal of ANH) once this is arrived to consequentially and prudently. A discussion of the religious dimension (and concerns) on the health care – patient relationship in the light of recent developments in Trinitarian ontology as applied to social settings is also introduced.