The Inaugural Gold Medal for Best Letter Submission 2013: The Need for Guidelines in Special Palliative Care

AuthorJohn Lombard
[2013] COLR
The Inaugural Gold Medal for Best Letter Submission 2013: The Need for
Guidelines in Special Palliative Care
John Lombard
The intersection between law and medicine is often a complex and politically sensitive area.
In recent years, issues in surrogacy, in-vitro fertilisation, and abortion have demonstrated this
point clearly. Palliative care is yet another delicate area where there is both a regulatory and
policy lacuna which needs to be addressed.
Palliative care is an approach which aims to reduce pain experienced by the patient near the
end of life. There are differing levels of palliative care with the highest being specialist
palliative care. This form of care was originally provided to people with a cancer diagnosis
but has expanded to provide care for people suffering from illnesses such as motor neurone
disease, AIDs, chronic obstructive pulmonary disease or it may be provided to the older
person based on their medical condition. Factors such as an ageing population and a projected
rise in cancer rates mean that palliative care has an increasingly important role in Irish
healthcare. Nevertheless, there is an absence of clear guidelines for many specialist palliative
care practices, particularly those which give rise to the most complex legal and ethical
concerns. In this regard, it is the practices of terminal sedation, and the withdrawal of
artificial nutrition and hydration, which need to be addressed.
It has been argued by some that terminal sedation is a form of slow euthanasia. This is a very
serious and potentially harmful comparison that risks clouding the role of palliative care. As
such, it is vital that medical professionals are given a clear ethical and legal framework in
which to work when providing specialist palliative care. This requires establishing the
guiding principles in this area as well as identifying legal constraints on these practices.
Terminal sedation is a form of continuous sedation and is usually administered where the
patient is perceived to be close to death. It may be administered for symptoms such as pain,
nausea or existential distress. The administration of sedation for suffering such as existential
distress and restlessness is controversial as sedation would be used to treat psychological
distress rather than physical pain experienced by the patient. Issues such as this need to be
clarified to ensure that patients can receive appropriate care according to their needs.

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