The ethical complexities of palliative sedation

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dc.contributor.advisorHall, Susanen_ZA
dc.contributor.authorOdell, Shannonen_ZA
dc.contributor.otherStellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy. Applied Ethics.en_ZA
dc.date.accessioned2023-11-22T14:27:55Zen_ZA
dc.date.accessioned2024-01-08T19:40:35Zen_ZA
dc.date.available2023-11-22T14:27:55Zen_ZA
dc.date.available2024-01-08T19:40:35Zen_ZA
dc.date.issued2023-12en_ZA
dc.descriptionThesis (MPhil)--Stellenbosch University, 2023.en_ZA
dc.description.abstractENGLISH 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.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Deel van die kontinuum van palliatiewe sorg aan die einde van die lewe is die ongewone, laastetoevlug praktyk van palliatiewe sedasie. Palliatiewe sedasie is die doelbewuste verlaging van die bewussyn van ʼn sterwende pasiënt om sy/haar lyding te verlig wanneer, ondanks alle vorige pogings van verligting, die pasiënt se ondraagbare simptome weerbarstig voortduur. Hierdie tesis ondersoek die vraag of palliatiewe sedasie aan die einde van ʼn lewe voldoende verdedig kan word vir die redes uiteengesit in die literatuur, insluitend eksistensiële lyding, en of hierdie redes toepaslik is in die SuidAfrikaanse konteks. Die navorsingsdoelwitte was veelvoudig. Aanvanklik was dit nodig om die begripsgrense van palliatiewe sedasie te bepaal deur ʼn oorsig te maak van die verskillende definisies en riglyne wat in die literatuur beskikbaar is, en om konsepte soos weerbarstigheid, verdraagbaarheid, pyn, lyding, eweredigheid, terminaliteit en bewussyn te verduidelik. Die redenering met betrekking tot die toediening van palliatiewe sedasie in eksistensiële lyding, word voorgelê. ʼn Oorsig van beskikbare bewyse dat palliatiewe sedasie nie die dood verhaas nie, sowel as ander tipes sedasie en praktyke soos vrywillige eutanasie, geneesheer-geassisteerde selfdood en die weerhou en onttrekking van voeding en hidrasie, het bygedra tot die verdere definisie van die konseptuele raamwerk vir palliatiewe sedasie. Vervolgens is die leerstelling van dubbele effek krities ontleed om die toepasbaarheid as ʼn morele regverdiging van palliatiewe sedasie te bepaal. Daarbenewens het ontleding van ander relevante raamwerke – naamlik prinsiplisme, utilitarisme, Kantianisme en deugsaamheid etiek – ʼn breër raamwerk verskaf vir die etiese oordeel van die kompleksiteite inherent tot palliatiewe sedasie. Laastens, die tentatiewe voorstel word gemaak dat Aristotle se “goue middeweg” oorweeg moet word, en dat die konsepte van verdraagsaamheid en medelye op ʼn spektrum voorgestel word, met die gesondheidspraktisyn en multidissiplinêre span wat die middeweg tussen die twee uiterstes volg. Dit is ʼn redelike argument ter versterking van gesondheidspraktisyn in die Suid-Afrikaanse konteks se morele redenering met betrekking tot palliatiewe sedasie. Verdere navorsing is nodig om empiriese kennis oor implementering van praktiese aspekte van palliatiewe sedasie te verbeter, vir die opstel van riglyne, sowel as verklaring van etiese basispunte om gesondheidspraktisyns te lei in hul besluite aan die einde van ’n pasiënt se lewe en om hul morele kommer met betrekking tot palliatiewe sedasie te verminder.af_ZA
dc.description.versionMastersen_ZA
dc.format.extent92 pagesen_ZA
dc.identifier.urihttps://scholar.sun.ac.za/handle/10019.1/129025
dc.language.isoen_ZAen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.rights.holderStellenbosch Universityen_ZA
dc.subject.lcshPalliative treatmenten_ZA
dc.subject.lcshTerminal careen_ZA
dc.subject.lcshEthical problemsen_ZA
dc.titleThe ethical complexities of palliative sedationen_ZA
dc.typeThesisen_ZA
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