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The Ethics of Sedation In the Management of Refractory Symptoms at the End of Life
N. Cherny, M. van Bueken, M. van de WateringIn patients with advanced cancer and other terminal illnesses, a readiness to address pain and other intolerable symptoms is a medical and moral imperative (1). This has been described by Roy as the “emancipation principle of palliative care” which states: " spare no scientific or clinical effort to free dying persons from twisting and racking pain that invades, dominates and shrivels their consciousness, that leaves them no psychic or mental space for the things they want to think and say and do before they die." (3). Indeed there is a broad ethical consensus that, at the end of life, the provision of adequate relief of symptoms is an overriding goal, which must be pursued even in the setting of a narrow therapeutic index for the necessary palliative treatments (1, 4-13).
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