• Tze Ling Gwendoline Beatrice Soh, KrishnaLalit Kumar RadhaLKDivision of Palliative Medicine, National Cancer Centre, Singapore.Duke-NUS Medical School, National University of Singapore, Singapore.Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapo, Shin Wei Sim, and Alethea Chung Peng Yee.
• Division of Palliative Medicine, National Cancer Centre, Singapore.
• Singap Med J. 2016 May 1; 57 (5): 220-7.

AbstractLipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. Copyright: © Singapore Medical Association.

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