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[ed. Terminal Sedation is meant to be used to provide relief for agitation when nothing else works. This definition has morphed into sedating into a coma with the intent to end lives.]

by Wesley J. Smith (below), with response by Ron Panzer
Comment from Ron Panzer:
Ron Panzer, President of Hospice Patients Alliance was asked to respond to Smith’s article by advocate and journalist, Matt Abbott.

Wesley Smith is on the right track, but clearly not a nurse who has worked in hospice and dealt with patients at the end-of-life. He confuses the terms “terminal sedation,” “palliative sedation” and what is supposed to occur and what is being done in the name of either.

And “terminal sedation” or “palliative sedation” was NEVER mainly used as a pain control method. It was mostly used in the case of agitated patients, and to a lesser extent, for patients whose pain could not be managed well otherwise.

What was always known before as “terminal sedation,” was properly applied for certain clinical conditions: the sedating of a patient whose extreme agitation (called “terminal agitation at the end-of-life”), delusional or psychotic state, or extreme pain could not be managed any other way, making him a danger to himself or others, or allowing his continued suffering.

This “terminal sedation” properly protects the patient from himself and helps to achieve relief from those distressing symptoms. There is nothing in the original use of “terminal sedation” that required the patient to be denied artificial fluid and nutrition through a feeding tube, IV or other route.

The new use of “terminal sedation intentionally to end lives” is the “Third Way” used in many hospices, some hospitals and elsewhere.

This misuse of terminal sedation involves the sedating of patients who are not terminally agitated, delusional or psychotic and have no clinical need to be sedated.

They are sedated into a coma where they obviously are not conscious enough to safely eat or drink. They are intentionally denied nutrition and liquids orally because to do so would cause aspiration of the materials into the lungs.

Since this type of “terminal sedation” keeps the patient comatose permanently, they die of dehydration. The fluid volume of the blood decreases to the point where the circulatory system fails, cannot pump because there isn’t enough to maintain blood pressure.

Hospice workers who misuse “terminal sedation” to intentionally end patients’ lives often sedate the patient into a coma through an overdose of morphine or other opioid, or simply give more sedatives than are needed.

They then tell the family that the patient is “obviously dying” and cannot be fed or given fluids or “it could go into his lungs!” The families report to me that the patients often were eating, drinking, talking, even walking immediately before being sedated and all of a sudden became comatose, often right after hospice became involved, or a particular nurse was involved.

Calling the proper use of terminal sedation “palliative sedation” and labeling the improper intentional killing of patients through sedation “terminal sedation” is an inaccurate use and understanding of the terminology.

“Terminal sedation” always was a form of “palliative” care and thus could always have been called “palliative sedation” if one chose to do so. Wesley Smith makes a difference where none existed before, but misses the point.

The point is that according to the clinical standards for palliative care, terminal sedation was, and is, only used where other methods fail to provide relief. And, it did NOT necessarily have to be applied at the very end point where death was imminent. It was used where other methods failed to provide relief, plain and simple.

The statement of the NHPCO is generally correct, but fails to point out that many hospices and/or their staff MISUSE terminal sedation to necessitate the withholding of fluids and nutrition, thereby causing death. Hospice staff tell the family (after they have induced a coma):
“the patient is in a coma; if he ate or drank it would go into his lungs; you don’t want him to drown, do you?”

And so it goes, families are coerced into watching their loved one killed, slowly, through medically-induced comas, consequent medically-induced inability to eat or drink, and consequent death through dehydration.

I’ve heard about this scenario innumerable times. The story is always the same. This is the most widely used method of killing in America.

If people contemplate and really see the sanctity of life, their “quality of life” arguments fall away and they will understand that we are here to care for each other, not to kill each other.

Caring, and not convenience, is the sign of a civilized and just society!

Preserving the original hospice mission…

Ron Panzer
for Hospice Patients Alliance

Proper Palliative Sedation Not Same as Assisted Suicide’s “Terminal Sedation”
by Wesley J. Smith
May 13, 2010,

The assisted suicide movement is ever about blurring vital distinctions and deconstructing crucial definitions. One target has been the proper pain control technique known as palliative sedation, a rarely required procedure in which patients near death are sedated to control pain or other symptoms such as severe agitation or air hunger that cannot be alleviated in any other manner.

Confusion about this–some of it intentionally sown by assisted suicide advocates–induced the National Hospice and Palliative Care Organization to issue a statement clarifying the proper methods and purposes of sedation as a palliative technique. From the statement:


For the small number of imminently dying patients whose suffering is intolerable and refractory, NHPCO supports making the option of palliative sedation, delivered by highly trained healthcare professionals acting as an interdisciplinary team, available to patients.


Since the goal is symptom relief (and not unconsciousness per se), sedation should be titrated to reduce consciousness to the minimum level necessary to render symptoms tolerable. For most patients this will mean less than total unconsciousness, allowing the patient to rest comfortably, but to be aroused…

Relationship to Euthanasia and Assisted Suicide

Properly administered, palliative sedation of patients who are imminently dying is not the proximate cause of patient death, nor is death a means to achieve symptom relief in palliative sedation. As such, palliative sedation is categorically distinct from euthanasia and assisted suicide.

Contrast this with the intentional misdefinition of palliative sedation two pro assisted suicide legislators tried to foist on California (AB 2747), under the influence of Compassion and Choices, which would have mutated palliative sedation into terminal sedation via induced coma and dehydration:

442 (d) “Palliative sedation” means the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious, while artificial food and hydration are withheld, during the progression of the disease leading to the death of the patient.

That didn’t pass. But the crucial difference between palliative sedation–as described by the NHPCO–and terminal sedation–favored by the death with dignity crowd–is the difference between medically caring properly for patients and turning killing into both a means and an end.

[Printed from: ; Note: Wesley J. Smith, J.D., is a special consultant to the Center for Bioethics and Culture. Excerpted from his A Rat Is a Pig Is a Dog Is a Boy: The Human Cost of the Animal Rights Movement (Encounter, 2010)… N Valko RN, 18May10]