Euthanasia vs. Palliative Sedation: Is There a Difference?

Most oncology nurses have had the experience of treating terminally ill cancer patients with an escalated dose of sedatives to help relieve suffering and achieve comfort as they near the end of their lives. Death generally follows after a patient has become this heavily sedated.

Some may wonder if this is type of treatment is considered euthanasia. Well, technically, considering that euthanasia is illegal in the United States, the answer would be "no." But is there really a difference between euthanasia and palliative sedation?

By definition, euthanasia is the act of ending a patient's life in response to pain and suffering by administering a high dose of Phenobarbital with the addition of concentrated potassium chloride via an intravenous route. This type of treatment is generally administered by a physician with the intent to cause death, and it will ultimately halt respirations and cause cardiac arrest.

In contrast, the intent of palliative sedation is to relieve pain and suffering caused by a terminal illness, but not to cause death. Generally, nurses and physicians will administer increased doses of Scheduled II medications, considered opiates, in order to achieve this level of comfort. The goal of palliative sedation is to relieve suffering when a patient is close to death. Death may occur with this type of sedation, but it remains unclear if the death is caused by increased sedation or the illness itself.

It is important to note that there is another form of sedation that may also cause death, and this is referred to as Physician-Assisted Suicide (PAS). This form of treatment is implemented by the physician, who writes a prescription for a lethal dose of a Scheduled II medication for the patient, who administers the medication to himself. PAS is currently legal in the United States in the states of Oregon and Washington, in addition to some countries outside of the US.

So, in brief, the difference is the intent. With that being said, even though the intent differs, the result is ultimately the same. As oncology nurses and physicians prepare to offer palliative sedation, do we understand that frequent, increased doses of sedation will in turn cause death for most cancer patients and ultimately advance the death process?

Your answer may stem from science or the belief in a higher being, but one other question to ponder is this: Should we as humans be allowed to make the decision of implementing euthanasia and/or PAS for ourselves, if we are suffering from a terminal illness?