We wish to correct the inaccuracies in the CMAJ article by Tibbetts1 on Quebec’s end-of-life bill. Tibbetts writes … “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.” Where the author obtained this information is unclear, but the two paragraphs that follow contain quotes from a health law ethics professor and a retired palliative care physician — both of whom claim there are no “rules” and imply that this process is happening frequently.
The Canadian Society of Palliative Care Physicians formed a task force to review and develop a framework for the use of palliative sedation.2 This framework outlines the indications, decision-making, drugs and monitoring to be used in palliative sedation.
Tibbett’s1 assertation also implies that palliative sedation hastens death by dehydrating patients who are too sedated to eat or drink. In a recent systematic review of 11 retrospective and prospective studies involving 1807 patients, with 621 patients receiving sedation, no substantial difference between sedated and nonsedated patients was found.3 A recent prospective study found that palliative sedation was a definable clinical intervention that had no effect on survival.4 Both studies noted the most frequent reason for palliative sedation was delirium.
The debate about physician-assisted death is too important of an issue to be hampered by inaccuracies and misrepresentation.