Browsing by Author "Odell, Shannon"

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    The ethical complexities of palliative sedation
    (Stellenbosch : Stellenbosch University, 2023-12) Odell, Shannon; Hall, Susan; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy. Applied Ethics.
    ENGLISH ABSTRACT: Within the realms of the continuum of palliative care at the end-of-life, is the rare, last-resort practice of palliative sedation. Palliative sedation is the intentional lowering of an imminently dying patient’s consciousness to relieve their suffering, when despite all prior attempts at reprieve, the patient’s intolerable symptoms remain refractory. This thesis probes whether palliative sedation can be justified sufficiently at the end-of-life for the reasons set out in the literature, including existential suffering, and whether these reasons are relevant in the South African context. The research objectives were multiple. Initially, it was necessary to establish the conceptual boundaries of palliative sedation by reviewing the various definitions and guidelines available in the literature, and clarifying concepts such as refractoriness, tolerability, pain, suffering, proportionality, terminality and consciousness. The arguments pertaining to the application of palliative sedation to existential suffering were presented. Reviewing the available evidence regarding palliative sedation not hastening death, and other types of sedation and practices such as voluntary euthanasia, physicianassisted suicide and the withholding and withdrawal of nutrition and hydration helped to define the conceptual framework for palliative sedation further. Subsequently, the doctrine of double effect was critically analysed for its applicability as a moral justification of palliative sedation. In addition, analysis of other relevant moral frameworks - namely principlism, utilitarianism, Kantianism and virtue ethics - provided a broader framework for the ethical discernment of the complexities inherent to palliative sedation. Finally, the tentative suggestion was made to consider Aristotle’s “golden mean” and the concepts of tolerability and compassion being represented on a spectrum, with the healthcare practitioner and multidisciplinary team pursuing the intermediate between the extremes. This seems reasonable to equip healthcare practitioners in the South African context to strengthen their moral reasoning regarding palliative sedation. Further research is required to increase empirical knowledge relating to the practical aspects of palliative sedation implementation and guideline development, and also to clarify ethical constructs to guide healthcare practitioners navigating end-of-life decisions and to reduce their moral distress pertaining to palliative sedation.