ABSTRACT
The practice of palliative sedation Various defi nitions of ‘palliative sedation’ have been suggested, but the common goal is to reduce intractable physical and existential distress, up to the point of inducing and maintaining a deep sleep, but not deliberately causing death.1 However, it is possible that the treatment itself may have the unintended consequence of hastening the patient’s inevitable demise. This is the so-called ‘double (or dual) effect’, which was fi rst enshrined in British law in the infamous Bodkin Adams case.2,3 This doctrine can be summarised as follows:
The duty of the doctor or nurse is to relieve suffering, and it is permissible to administer drugs in order to achieve this; however, a patient at the end of their life, who is suffering greatly, may require such large drug doses to preserve their comfort and dignity that the possible side-effects of these drugs (such as respiratory depression) may incidentally accelerate the act of dying.
