The controversy over the equivalence of continuous sedation until death (CSD) and physician-assisted suicide/euthanasia (PAS/E) provides an opportunity to focus on a significant extended use of CSD. This extension, suggested by the equivalence of PAS/E and CSD, is designed to promote additional patient autonomy at the end-of-life. Samuel LiPuma, in his article, “Continuous Sedation Until Death as Physician-Assisted Suicide/Euthanasia: A Conceptual Analysis” claims equivalence between CSD and death; his paper is seminal in the equivalency debate. Critics contend that sedation follows (...) proportionality protocols for which LiPuma’s thesis does not adequately account. Furthermore, sedation may not eliminate consciousness, and as such LiPuma’s contention that CSD is equivalent to neocortical death is suspect. We not only defend the equivalence thesis, but also expand it to include additional moral considerations. First, we explain the equivalence thesis. This is followed by a defense of the thesis against five criticisms. The third section critiques the current use of CSD. Finally, we offer two proposals that, if adopted, would broaden the use of PAS/E and CSD and thereby expand options at the end-of-life. (shrink)

For the last fifty years, the United States healthcare system has done an extremely poor job of delivering healthcare in a just and fair manner. The United States holds the dubious distinction of being the only industrialized nation in the world lacking provisions to ensure universal coverage. We attempt to provide some of the reasons this dysfunctional system has persisted and show that healthcare should not be a commodity. We begin with a brief historical overview of healthcare delivery in the (...) United States since WWII. This is followed by a critical analysis of the for-profit model including reasons to support the view that healthcare should not be a free market commodity. We also demonstrate how special interest groups have been able to win support for their practices based on propaganda rather than fact. A brief analysis of the Affordable Care Act is offered along with critical comments regarding its ineffectiveness. We conclude with a brief overview of international approaches that have resulted in universal coverage and suggest the United States ought to adopt an approach similar to those outlined so that it no longer stands as the only industrialized nation to ignore the glaring problems that exist. (shrink)

Susan D. McCammon and Nicole M. Piemonte offer a thoughtful and thorough commentary on our manuscript entitled “Expanding the use of Continuous Sedation Until Death.” In this reply we attempt to clarify and further defend our position. We show how continuous sedation until death is not a “first resort” but rather a legitimate option among many that should available to terminally ill patients whose life expectancy is less than six months. We also attempt to show that we do not equivocate (...) the meaning of palliative care as the commentators suggested. We argue that the traditional notion of palliative care should move beyond relief of “experienced suffering” to relief of potential suffering for those whose life expectancy is less than six months. Lastly, we challenge the commentator’s position that the realm of ordinary medicine” should be the guide to care, by showing how the notion of ordinary medicine has been successfully challenged in both bioethical scholarship and the courts in a way that shows ordinary medicine to be an evolving concept rather than a static, universal guide. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 48-49, June 2011.

As currently practiced, the use of continuous sedation until death (CSD) is controlled by clinicians in a way that may deny patients a key choice in controlling their dying process. Ethical guidelines from the American Medical Association and the American Academy of Pain Medicine describe CSD as a “last resort,” and a position statement from the American Academy of Hospice and Palliative Medicine describe it as “an intervention reserved for extreme situations.” Accordingly, patients must progress to unremitting pain and suffering (...) and reach a last-resort stage before the option to pursue CSD is considered. Alternatively, we present and defend a new guideline in which decisionally capable, terminally ill patients who have a life expectancy of less than six months may request CSD before being subjected to the refractory suffering of a treatment of “last resort.”. (shrink)

This book examines when it is morally appropriate for medical intervention to hasten the dying process. The authors’ overriding goal is to humanize the dying process by expanding patient centered autonomous control.

Recently both whole brain death (WBD) and higher brain death (HBD) have come under attack. These attacks, we argue, are successful, leaving supporters of both views without a firm foundation. This state of affairs has been described as “the death of brain death.” Returning to a cardiopulmonary definition presents problems we also find unacceptable. Instead, we attempt to revive brain death by offering a novel and more coherent standard of death based on the permanent cessation of mental processing. This approach (...) works, we claim, by being functionalist instead of being based in biology, consciousness, or personhood. We begin by explaining why an objective biological determination of death fails. We continue by similarly rejecting current arguments offered in support of HBD, which rely on consciousness and/or personhood. In the final section, we explain and defend our functionalist view of death. Our definition centers on mental processing, both conscious and preconscious or unconscious. This view provides the philosophical basis of a functional definition that most accurately reflects the original spirit of brain death when first proposed in the Harvard criteria of 1968. (shrink)