Mayo Clinic review of ethical decision making with end-of-life care

In a review article published in the October issue of Mayo Clinic Proceedings, Mayo Clinic physicians differentiate the ethical and legal permissibility of withholding or withdrawing life-sustaining treatments and accepted comfort measures, specifically palliative sedation, from that of physician-assisted suicide or euthanasia.

Physician reviewers find that palliative sedation has an important place on the continuum of appropriate palliative care. "At the end of life, patient goals often shift to comfort, and removal of burdens and relief of suffering become paramount," says lead author, Paul Mueller, M.D., General Internal Medicine, Mayo Clinic.

"Many physicians are uncomfortable removing life-sustaining therapy or providing comfort-directed medication because of confusion about the ethical soundness of such treatments. In contrast to physician-assisted suicide or euthanasia, withdrawal of or withholding life-sustaining treatment and administering palliative sedation are ethically sound options."

Palliative sedation is appropriate therapy for refractory and unacceptably severe suffering. "As with any other therapy, the patient or surrogate should be informed of potential adverse effects, including loss of social interaction and potential for life-threatening aspiration or respiratory depression. Palliative medicine teams should be involved, if possible, in any case in which palliative sedation is considered," says Dr. Mueller.

"We hope that by increasing familiarity with the ethical basis for these practices we will encourage their appropriate application," he adds.