Questions éthiques associées à la pratique de la sédation en phase terminale

The practice of terminal sedation brings up a number of ethical questions about terminology, indications, definition of the refractory symptoms and dividing line between sedation and euthanasia. The questions are more important in situations like psycho-existential suffering or withdrawal/withholding of treatment. For number of physicians, palliative sedation has an unclear border with euthanasia. The authors analyze this aspect by referring to the factual data and ethical analyses relative to the situation in the Netherlands, to the controversies about withdrawal/withholding hydration and to decisions of sedation which are extrinsic of the therapeutic goal. The authors discuss the criteria usually retained to make a distinction between sedation and euthanasia: physician's intention, respect for patient's autonomy, principle of proportionality and rule of the double effect. Careful procedures can be a mark of ethical decision-making: there is question of collectively deliberation, respect to the patient's opinion, decision's visibility; after all, emphasis is made on the limits of exclusively procedural solutions.