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Discussions around continuous deep sedation until death Volume 15, issue 5, Mai 2019

Authors
Université Jean Monnet, Faculté de médecine Jacques Lisfranc, Département de Médecine Générale, 42270 Saint-Priest-en-Jarez
* Correspondance

The Claeys-Leonetti law of 2016 gives the right of continuous deep sedation until death (SPCMD) for end-of-life patients. This law is the subject of ethical controversies which probably explains the reluctance of so many doctors to apply it. This article offers a reflection about the ethical limits of the SPCMD and of euthanasia, on the definition of refractory pain, of mental suffering, of short-term prognosis, of sedation techniques and of stopping artificial feeding and hydration. Intentionality is the ethical concept the most often found to differentiate SPCMD and euthanasia. It's analysis during the collegial procedure can help doctors in their decisions. The definitions of the different types of sedation help doctors to understand their indications. The indication of sedation during refractory existential symptoms divides doctors fearing the slippery slope that is the medicalization of dying. The transitory sedation seems to be “the middle path”. The principle of double effect applies to SPCMD, but in a more difficult way to the stopping of artificial feeding and hydration, which remains a very difficult decision with loaded symbols. The practice of SPCMD needs to analyse one's intentions, to take into account the double effect and to think of other care such as analgaesic and the eventual stopping of nutrition and hydration.

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