A currently debated issue in bioethics is whether the presently legal practices of withholding and withdrawing of life-sustaining treatment (hereafter WWLST) and terminal sedation will lead to the more controversial practice of euthanasia. In the following post I will give a brief description of WWLST and terminal sedation and give a few reasons why they are morally permissible. Then I will suggest why the moral permissibility of these practices does not necessarily commit one to the view that euthanasia is also morally permissible.
According to the American Medical Association (AMA), life-sustaining treatment is “any treatment that serves to prolong life without reversing the underlying medical condition” (AMA). Such treatment can include respirators, artificial nutrition and hydration, and chemotherapy. Although the patient’s death will likely follow WWLST, this practice is generally considered to be morally permissible when the patient consents because it is a case of letting the patient die, rather than directly killing her. While physicians have a duty to sustain their patients’ lives, they are not morally required to do everything possible to prolong life; they also have a duty to relieve their patients’ suffering. The AMA holds that in situations in which these duties conflict, the patient’s desires should be the deciding factor.
Terminal sedation is a bit more complicated. According to the AMA, terminal sedation is “the use of high doses of sedatives to relieve extremes of physical distress. Its purpose is to render the patient unconscious to relieve suffering until the patient dies from his or her disease processes and their complications” (AMA). The specific type of terminal sedation I will refer to is terminal sedation coupled with WWLST where the patient is sedated and then life-sustaining treatment is either not provided or removed. The question is whether there is a relevant moral difference between WWLST by itself and terminal sedation coupled with WWLST. I argue that there is no significant moral difference. The only difference in practice is that with terminal sedation the patient is sedated first. It may be argued that this difference is significant because by sedating the patient the physician is sometimes creating a need for life-sustaining treatment that was not already present. However, sedating a patient is morally permissible when it is the only way to control the patient’s pain. Thus, sedating the patient and thereby creating the need for life-sustaining treatment is morally permissible. Once the patient is sedated, there is no moral difference between withholding or withdrawing life-sustaining treatment for the sedated patient versus for the non-sedated patient.
When terminal sedation is coupled with WWLST, it begins to look a lot like euthanasia. However, I believe there is a relevant difference. With euthanasia the physician administers the patient a lethal drug or injection. Hence, while terminal sedation is a case of letting the patient die, euthanasia is a case of actively killing the patient. Consequently, holding that WWLST and terminal sedation are morally permissible does not commit one to the view that euthanasia is also permissible. With WWLST and terminal sedation it is believed that letting die is morally permissible. In order to show that euthanasia is morally permissible, one would have to show that killing is morally permissible. However, even though we cannot go directly from the moral permissibility of WWLST and terminal sedation to that of euthanasia, there may be other reasons as to why euthanasia may be morally permissible.