Access Type

Open Access Dissertation

Date of Award

January 2013

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Philosophy

First Advisor

Bruce Russell

Abstract

Professionals engaged in palliative care have a responsibility to treat their patients by aggressively managing pain and certain kinds of suffering within legal and professional ethical boundaries. Many medical professionals and ethicists, rightly or wrongly, have considered the practices of euthanasia and physician-assisted suicide, which can be categorized as instances of physician-assisted death (PAD), to be beyond the scope of ethically appropriate health care. Many of these same individuals who oppose PAD, and the professional organizations they sometimes represent, often embrace, at the same time, the practice of palliative/terminal sedation at the end of life. Palliative sedation is thought to be an advance in palliative care that has alleviated the need for PAD when managing otherwise intractable pain in dying patients. However, there is some question as to whether this procedure is sufficiently distinct, ethically speaking, from instances of various forms of PAD and that it actually constitutes a compromise. It may be argued that if there is no legitimate moral distinction between the two sets of practices, then instances of PAD should be legal and morally legitimate end-of-life treatment options for patients along with palliative sedation. If this view is correct, then those who support the use of sedation in end-of-life palliative care should have no problem with the practice of PAD. If they were to think or act otherwise would be ethically and professionally inconsistent.

The primary question of this dissertation is to determine whether or not medical professionals and others invested in this area are ethically consistent if they reject PAD while embracing the practice of palliative/terminal sedation. So this project is to be considered a work in applied analytic bioethics. I argue that there are both conceptual and empirical reasons for maintaining that there are morally relevant differences between PAD and palliative/terminal sedation for those who have some reasons to think the former is ethically problematic. Therefore, those who are morally and professionally opposed to PAD for certain reasons are not necessarily being inconsistent in their support of palliative/terminal sedation as a legitimate treatment at the end-of-life when the latter is carefully defined, understood, and practiced.

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