The ethical case for extending the use of General Anaesthesia beyond the operating theatre to the care of dying patients who desire to be unconscious.

Mr Antony Takla

1Monash University, Clayton, Australia, 2Oxford Uehiro Centre for Practical Ethics, Oxford, United Kingdom

End of life care (EOLC) refers to palliative care for patients who are imminently dying. Management includes holistic care and symptom management. While there have been considerable advances in EOLC, a quarter to a third of all terminally ill patients experience refractory symptoms that require sedation. Palliative Sedation (PS), Terminal Sedation (TS) or continuous deep sedation (CDS) are all terms that refer to the practice of administering sedatives to help manage refractory symptoms in dying patients. Professional guidelines indicate that sedatives should be carefully titrated, aiming to provide the lowest dose needed to achieve comfort; it is thought that aiming directly at unconsciousness would be both unnecessary and unethical. However, for some patients, these interventions are not enough, and others may express a clear desire to be completely unconscious as they die. In this presentation, I explore the case for the use of General Anaesthesia in end-of-life care (GAEL). GAEL is the administration of an anaesthetic agent (such as propofol) to a dying patient with the clear aim of bringing about immediate unconsciousness (based on a competent patient request). I outline the ethical case for GAEL as a way of respecting patients’ wishes and of ensuring true patient comfort in their last few hours or days of life. It is important to note that GAEL is not intended to hasten death. Consequently, I respond to some potential objections, especially around the alleged inherent dangers of general anaesthesia and the applicability of the doctrine of double effect.


Biography:

Antony is a final-year medical student at Monash University. In 2020, he completed a biomedical science (honours) degree at Monash University and in collaboration with the Oxford Uehiro Centre for Practical Ethics where he explored the ethics of sedation in end-of-life care.

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