End-of-Life Care

image of a statue of a family members at deathbed

Press Releases

Medical and ethical experts say ‘make general anaesthesia more widely available for dying patients’ (21 April 2021)

General anaesthesia is widely used for surgery and diagnostic interventions, to ensure the patient is completely unconscious during these procedures. However, in a paper published in Anaesthesia (a journal of the Association of Anaesthetists) ethics and anaesthesia experts from the University of Oxford say that general anaesthesia should be more widely available for patients at the end of their lives.
Press Release: Medical and ethical experts say ‘make general anaesthesia more widely available for dying patients

Majority of UK public want choice at the end of life – survey (24 March 2021)

The latest research from Oxford University’s Uehiro Centre for Practical Ethics breaks new ground. It finds strong support for access to deep sedation in dying patients, with 88% of respondents saying they would want the option of a general anaesthetic if they were dying, while 79% would want the option of euthanasia.

Media

Practical Ethics in the News Blog: General Anaesthesia in End of Life Care – GAEL. Published April 21, 2021 | By Dominic Wilkinson

Practical Ethics in the News Blog: End-of-Life Care: People Should Have the Option of General Anaesthesia as They Die. Published April 27, 2021 | By Dominic Wilkinson and Julian Savulescu

For a collection of older Practical Ethics in the News blogs on this topic, go to our blog website here.

Podcast: 'Sleep softly: Ethics, Schubert and the value of dying well'.  An inter-disciplinary collaboration on music, mortality and ethics including a performance of Schubert’s String Quartet Number 14 (second movement). Dominic Wilkinson (23 May 2018).

LBC Radio (with Nick Ferrari): Dominic Wilkinson discusses whether general anaesthesia should be offered to patients at end-of-life (28 April 2021) [02:35:30 on the clock]

Open Access Publications

Takla, A., Wilkinson, D., Pandit, J. and Savulescu, J., (forthcoming 2021), 'General anaesthesia in end-of-life care: extending the indications for anaesthesia beyond surgery', Anaesthesia, Vol: online 20 April 2021

Summary: In this article, we describe an extension of general anaesthesia – beyond facilitating surgery – to the relief of suffering during dying. Some refractory symptoms at the end of life (pain, delirium, distress, dyspnoea) might be managed by analgesia, but in high doses, adverse effects (e.g. respiratory depression) can hasten death. Sedation may be needed for agitation or distress and can be administered as continuous deep sedation (also referred to as terminal or palliative sedation) generally using benzodiazepines. However, for some patients these interventions are not enough, and others may express a clear desire to be completely unconscious as they die. We summarise the historical background of an established practice that we refer to as ‘general anaesthesia in end‐of‐life care’. We discuss its contexts and some ethical and legal issues that it raises, arguing that these are largely similar issues to those already raised by continuous deep sedation. To be a valid option, general anaesthesia in end‐of‐life care will require a clear multidisciplinary framework and consensus practice guidelines. We see these as an impending development for which the specialty should prepare. General anaesthesia in end‐of‐life care raises an important debate about the possible role of anaesthesia in the relief of suffering beyond the context of surgical/diagnostic interventions.

Takla, A., Wilkinson, D. and Savulescu, J., (2021), 'A conscious choice: is it ethical to aim at unconsciousness at the end of life', Bioethics, Vol: 35(3): 284-291 [PMC8243249]

Abstract: One of the most commonly referenced ethical principles when it comes to the management of dying patients is the doctrine of double effect (DDE). The DDE affirms that it is acceptable to cause side effects (e.g. respiratory depression) as a consequence of symptom‐focused treatment. Much discussion of the ethics of end of life care focuses on the question of whether actions (or omissions) would hasten (or cause) death, and whether that is permissible. However, there is a separate question about the permissibility of hastening or causing unconsciousness in dying patients. Some authors have argued that the DDE would not permit end of life care that directly aims to render the patient unconscious. The claim is that consciousness is an objective human good and therefore doctors should not intentionally (and permanently) suppress it. Three types of end of life care (EOLC) practices will be explored in this article. The first is symptom‐based management (e.g. analgesia); the second is proportional terminal sedation as a means of relieving suffering (also referred to as palliative sedation or continuous deep sedation); and finally, deliberate and rapid sedation to unconsciousness until death (a practice we call terminal anaesthesia in this paper). After examining the common arguments for the various types of symptom‐based management and sedation, we apply the DDE to the latter two types of EOLC practices. We argue that aiming at unconsciousness, contrary to some claims, can be morally good or at least morally neutral in some dying patients.

Takla, A., Savulescu, J., Kappes, A. and Wilkinson, D., (2021), 'British laypeople’s attitudes towards gradual sedation, sedation to unconsciousness and euthanasia at the end of life', PLoS ONE, Vol: 16((3):e0247193) [PMC7997648]

Abstract: Many patients at the end of life require analgesia to relieve pain. Additionally, up to 1/5 of patients in the UK receive sedation for refractory symptoms at the end of life. The use of sedation in end-of-life care (EOLC) remains controversial. While gradual sedation to alleviate intractable suffering is generally accepted, there is more opposition towards deliberate and rapid sedation to unconsciousness (so-called “terminal anaesthesia”, TA). However, the general public’s views about sedation in EOLC are not known. We sought to investigate the general public’s views to inform policy and practice in the UK.

Wilkinson, D., (2021), 'Sleep softly. Schubert, ethics and the value of dying well', Journal of Medical Ethics, Vol: 47(4) [PMC8053338]

Abstract: Ethical discussions about medical treatment for seriously ill babies or children often focus on the ‘value of life’ or on ‘quality of life’ and what that might mean. In this paper, I look at the other side of the coin—on the value of death, and on the quality of dying. In particular, I examine whether there is such a thing as a good way to die, for an infant or an adult, and what that means for medical care. To do that, I call on philosophy and on personal experience. However, I will also make reference to art, poetry and music. That is partly because the topic of mortality has long been reflected on by artists as well as philosophers and ethicists. It is also because, as we will see, there may be some useful parallels to draw.