Philosophical and ethical issues of sedation in the terminal phase of disease: a return to existential questions

Sedation in the terminal phase of disease or outside any progressive pathology leads us today to rethink the paradigm of life, existence and destiny. This paper addresses the philosophical issue of the “desire to live” and the “un-willingness to live”. For any person – sick or not – who has no belief in “another” life, or in a superior being who is the master of their life, is it legitimate to force them to wait for their “death”? Should doctors or their relatives decide on their “life” and “death” by keeping them “alive” for the inevitable outcome? The current debate seems to make doctors and relatives of terminally ill patients feel guilty, accusing them of “deliberate-murder”; the State itself, by refusing to legalize euthanasia through sedation is accused of “moral-torture”. Among practitioners, the debate is no less heated and the arguments put forward on both sides – whether for terminal sedation or for the rejection of a form of “assisted suicide” – are shaking the philosophers in their reflection more than we think. Arguments such as “accomplished life” and “life fatigue” are increasingly raised and could justify the free choice of euthanasia by elderly people, or those tired of living! The aim of this article is threefold to1. lay the foundations of the contemporary debate on the progress of medicine in the management of physical and psychological pain/suffering; 2. help relatives in their duty to assist; and finally, 3. provide practitioners with benchmarks and points of reference, respecting the Hippocratic Oath, and their duties as humanists.