Managing Death: Suffering, the Narrative Self, and the Ethics of Continuous Deep Sedation

Since the early 1990s, palliative sedation has been an important intervention for select patients at the end of life. A subset of sedation practices is increasingly being resorted to: continuous deep sedation until death (CDS). CDS is clinically and ethically indicated when a patient experiences a symptom that is refractory to state-of-the-art palliative interventions. Refractory symptoms are generally associated with physical distress. Yet equally important to a patient is the suffering caused by a loss of meaning and the significance of an impending death. This latter kind of suffering has been called “existential suffering.” An important question in recent years has been the extent to which a physician may relieve existential suffering. Most professional medical guidelines and practitioners deny CDS for existential suffering. A distinction is thus drawn between suffering that has a direct causal link to an underlying illness and suffering that does not. The purpose of this dissertation is to explore the ethics of CDS for existential suffering at the end of life.