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Second Story: Sedation with Dehydration used as “Slow Euthanasia” UK Survey Reveals

“Slow euthanasia by deep sedation” is a current reality in the British health care system, and not just a journalistic myth, a survey of UK doctors has revealed.

The study found that continuous deep sedation (CDS) was more frequently requested by patients or relatives seeking a “hastened death” and was associated “with a greater incidence of other end-of-life decisions containing some intent to end life by the doctor”.

Under existing medical care protocols in the UK, patients who are designated as dying, can have food and hydration withdrawn until they die of dehydration, even when continued hydration can still be of medical benefit.

“Doctors supporting legalization of euthanasia or physician-assisted suicide, or who were nonreligious, were more likely to report using CDS,” the researchers found.

Published in the Journal of Pain and Symptom Management, the survey also said that 18.7 per cent of the 2,923 doctors polled used CDS to keep patients unconscious for long periods to control pain, most often for those who were dying of cancer. Ethicists say that this use of CDS is legitimate if it is not in conjunction with premature withdrawal of hydration. The study also noted that “specialists in care of the elderly were least likely to report the use of CDS”.

Critics of the Liverpool Care Pathway (LCP), a widely used protocol for treating the terminally ill, have said that it is a “pathway to death” that presumes the intention to end the life of the patient.

In September, after the publication of a letter by physicians warning that the LCP is hastening the death of patients who are often refused food and hydration, pro-life leaders in the UK said that through a combination of existing legislation and various end-of-life medical care protocols, euthanasia has been effectively made legal in the UK without any act of the government.

John Smeaton, Director of the Society for the Protection of Unborn Children (SPUC), Europe’s leading pro-life organisation, told LSN, “We have a government policy of silent euthanasia right now in this country.

“This is being brought about through a number of different factors, but significantly the Mental Capacity Act of 2005, that formally defined the provision of food and fluids as medical treatment.” [30October09, Hilary White, London,]


British Doctors Practicing “Slow” Euthanasia through Deep Sedation

BBC Report has revealed that physicians in the UK are increasingly seeing and using “continuous deep sedation” as a form of “slow” euthanasia.

Adam Brimelow, BBC News health correspondent, writes that the use of continuous deep sedation, also known as “terminal sedation” is becoming more common in the UK and may be the way physicians are skirting the law prohibiting direct euthanasia.

Research has shown that 16.5 percent of all deaths in the UK are associated with continuous deep sedation until death, a number twice that of Belgium and the Netherlands, both countries that already have legalised direct euthanasia.

Deep sedation can be used intermittently or continuously until death, and the depth of sedation can vary from a lowered state of consciousness to unconsciousness. Under UK law, patients can give a directive to medical staff that they refuse ‘palliative care’ or ‘terminal sedation’, or ‘any drug likely to suppress respiration’.

Alex Schadenberg, the head of Canada’s Euthanasia Prevention Coalition, said that continuous deep sedation is a technique that can be used ethically in cases of dying patients to alleviate intractable pain, such as neuropathic pain that does not respond to morphine, but the ethics depends upon the situation and the intention.

“It’s important to make the distinction,” Schadenberg told, “between what we do with someone who is nearing death and someone who is in pain but not dying.” In some cases, he said, patients who are not dying but may be suffering are put into deep sedation, and then dehydrated to death – a use that is always unethical.

However, “if your patient is nearing death and is experiencing organ failure, you really can’t be putting food and fluid into a body that can’t use the fluids. When the body is shutting down, this is a natural part of the dying process. But when they’re not dying, like Terri Schiavo, or someone who is experiencing great pain associated with cancer, that is a different issue, because then we are talking about causing that person’s death.

“[Deep sedation] can be a backdoor route to euthanasia if it is used unethically,” he said. “The issue is intention. The intention must be the alleviation of pain and suffering. Even a long-term sedation can be ethical as long as the person is not being dehydrated to death. A good palliative care physician won’t use the technique very often.”

Last year, Dutch researchers found that the use of continuous deep sedation until death was becoming more widespread in the Netherlands where direct euthanasia is already legal. In 2001, researchers found that in six European countries deep sedation was used in 8.5 percent of all deaths in patients with cancer and other diseases.

“The increased use of continuous deep sedation for patients nearing death in the Netherlands suggests that this practice is increasingly considered as part of regular medical practice,” said lead researcher Judith Rietjens, a postdoctoral researcher in the Department of Public Health at Erasmus University Medical Center in Rotterdam.

“Also, the use of continuous deep sedation may in some situations be a relevant alternative to the use of euthanasia for patients,” Rietjens said.

Deep sedation is associated now with approximately 10 percent of all deaths in the Netherlands, an increase that coincided with an increase in public disquiet about the numbers of active euthanasia cases – numbers that have since declined.

Schadenberg said that the answer to the puzzle is simple: “The statistics of active euthanasia have gone down in the Netherlands because they are simply resorting to deep sedation instead.

“But in fact this simply means that patients are being euthanised slowly in conjunction with the withdrawal of fluids. It is why this is being called ‘slow euthanasia’. A lethal injection is quicker, but in fact the ethics are no different. Both intend death.”

Judith Rietjens confirmed this, saying, “We can see in our study that those sub-groups where we saw an increase of continuous deep sedation – just in those sub-groups – we saw a lowering of the frequency of euthanasia.”

Related: Britain’s Pathway to Euthanasia – NHS Protocols for Dehydrating Disabled Patients to Death

Elderly Woman Rescued by Family from NHS Dehydration Order
[18Aug09, Hilary White, London,]