I am disappointed in Tibbett’s1 reporting in CMAJ on terminal sedation, Bill 52 and the euthanasia debate. The following statement appears in the article: “As it stands, hospitals in Quebec and the rest of Canada often offer palliative sedation to ease suffering. In extreme cases, doctors use ‘terminal sedation,’ in which patients are medicated into unconsciousness and deprived of artificial nutrition to expedite imminent death.”1
The term “terminal sedation” has fallen out of favour because it misrepresents the intent of the intervention. Palliative sedation, although not commonly used, is a medically respected and recognized intervention for patients with intractable symptoms, where the only option is to provide sedation to relieve suffering. Palliative sedation is normally offered only once a palliative care team has deemed symptoms to be intractable (e.g., meaning all reasonable and available avenues to relieve the patient’s suffering have been tried, explored and offered), and just not difficult to manage.
Palliative sedation can be light or deep, and the intent is to relieve the patient of intractable suffering, not to end the patient’s life. Patients are not “deprived” of artificial nutrition to expedite imminent death. If artificial nutrition is not a part of the care plan for the patient, it is not forced. In almost every case of palliative sedation, the patient is often near death, and to offer artificial nutrition is often futile and potentially harmful because it could cause additional symptoms.
While providing palliative care to patients, physicians often have to overcome myths and “untruths” (i.e., morphine hastens death, methadone is for patients with addictions, and patients are forced into palliative care to save the health care system money).