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PERSPECTIVE

Sedation, Alimentation, Hydration, and Equivocation: Careful Conversation about Care at the End of Life

Lynn A. Jansen, RN, PhD, and Daniel P. Sulmasy, OFM, MD, PhD

4 June 2002 | Volume 136 Issue 11 | Pages 845-849

In the recent medical ethics literature, several authors have recommended terminal sedation and refusal of hydration and nutrition as important, morally acceptable, and relatively uncontroversial treatment options for end-of-life suffering. However, not all authors use these terms to refer to the same practices. This paper examines the various ways that the terms terminal sedation and refusal of hydration and nutrition have been used in the medical literature. Although some of these practices are ethically appropriate responses to end-of-life suffering, others (at least as they are currently described in the medical ethics literature) are not. This paper identifies and discusses the principles that morally distinguish these practices from one another and specifically describes different features of medical practices and moral principles that affect the moral acceptability of various medical treatments. These distinctions reveal the complexity of the issues surrounding terminal sedation and refusal of hydration and nutrition, a complexity that has not been adequately addressed in recent discussions.

Author and Article Information

From Saint Vincent's Hospital, New York, and The Bioethics Institute of New York Medical College, Valhalla, New York.

Request for Single Reprints: Lynn A. Jansen, RN, PhD, The John J. Conley Department of Ethics, Saint Vincent's Hospital and Medical Center, 153 West 11th Street (NR815), New York, NY 10011; e-mail, ljansen{at}saintvincentsnyc.org.

Current Author Addresses: Dr. Jansen: The John J. Conley Department of Ethics, Saint Vincent's Hospital and Medical Center, 153 West 11th Street (NR 815), New York, NY 10011.

Dr. Sulmasy: The John J. Conley Department of Ethics, Saint Vincent's Hospital and Medical Center, 153 West 11th Street (NR 815), New York, NY 10011.

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