ABSTRACT
In recent years a large empirical literature has appeared on suffering at the end of life. In this literature it is recognized that suffering has existential and social dimensions in addition to physical and psychological ones. The non-physical aspects of suffering, however, are still understood as pathological symptoms, to be reduced by therapeutical interventions as much as possible. But suffering itself and the negative emotional states it consists of are intentional states of mind which, as such, make cognitive claims: they are more or less appropriate responses to the actual circumstances of the patient. These circumstances often are such that it would rather be a pathological symptom not to be sad and not to suffer. Suffering, therefore, is sometimes and to some extent a condition to be respected. Although I do not dispute that the alleviation of suffering is the main aim of palliative care, in pursuing that aim we should acknowledge a constraint of realism.
Subject(s)
Palliative Care/ethics , Stress, Psychological/psychology , Stress, Psychological/therapy , Terminal Care/ethics , Terminally Ill/psychology , Humans , Moral Obligations , Palliative Care/psychology , Philosophy, Medical , Terminal Care/psychologyABSTRACT
Guidelines that have been published on sedation until death take the following positions: the patient's consciousness should not be lowered more than is necessary for preventing her from suffering; it must be impossible to alleviate the suffering in any alternative way; and the patient's mere preference for dying peacefully cannot justify the procedure. Some guidelines also stipulate that purely existential suffering cannot do so either. I will discuss the (few) arguments that can be found in the literature for these restrictions. I will focus in particular on the argument that it is either a vital interest, or even a duty, of the patient to preserve consciousness as long as possible at all times. None of these arguments turn out to be convincing. On the other hand, deviation from the requirements can be justified only by appealing to the priorities of the patient. These should therefore have been discussed in detail at an earlier stage of the patient's illness.
