IT IS unfortunate that senior writer Andy Ho linked the concept of euthanasia with stealth ("Terminal sedation is stealthy euthanasia"; last Saturday).
By definition, intent is paramount in euthanasia: the intent to shorten a person's life, for whatever reason - for the relief of suffering and at the person's request. That is why proponents of euthanasia want it to be legalised.
Intentional killing by stealth is murder, as is euthanasia in those jurisdictions where it is illegal.
Dr Ho implies that practitioners kill their patients stealthily through dehydration, under the guise of deep, continuous sedation of the terminally ill.
Terminal sedation is practised very differently in different countries, and even in different institutions within a country.
It is reserved as a last resort for intractable physical symptoms or intractable suffering, for which all other means of relief are not effective.
Full consultation with the patient, family and the interdisciplinary team should be practised - there is no stealth about it.
Often, sedation is light and intermittent, allowing the patient to surface daily to enable eating and drinking, and to check on his preference for continued sedation.
In the Singapore context, under the Advance Medical Directive Act, a terminally ill person may opt to avoid extraordinary life-sustaining treatment, but still be given food and water, and palliative care.
In a similar vein, nutrition and hydration are provided during sedation, either by intermittently waking a patient up, or via a nasogastric tube, or fluids given intravenously or subcutaneously.
There is no intention to kill the patient by starvation or dehydration.
Much can be done, even when patients face intractable symptoms or suffering.
The key is consultation and good communication among healthcare staff, the patient and family members. Stealth has no place in the equation.
Sedation, carefully titrated and monitored, is a small but essential component in the range of resources against the ravages of disease, if patients are not to be robbed of a peaceful end in the presence of their loved ones.
This article was first published on Apr 9, 2015.
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