ABSTRACT
All guidelines take the following positions: the patient's consciousness should not be lowered more than is necessary for preventing her from suffering (titration); it must be impossible to alleviate the suffering in any alternative way; and the patient's mere preference for dying peacefully cannot justify the procedure. Some guidelines also stipulate that purely existential suffering cannot do so either. My aim in this chapter is to evaluate the few arguments I have found in the guidelines themselves and in the literature for these restrictions.
None of the arguments turn out to be convincing. Proportionality arguments depend on the aims that are considered legitimate ones, but patients may have good reasons to prefer deep sedation from the start. Excluding existential suffering as a possible ‘indication’ betrays a mistaken conception of suffering that denies that all suffering has an existential dimension (see Chapter 6). People's conceptions of a good death diverge in certain respects: some people want to be in control to the last, others prefer sliding down quietly into a deep sleep from which they will never awake. Why should doctors not be allowed to help them dying in this way?
However, it is only acceptable to relax the requirements for sedation until death if we thereby improve the quality of a person's death as defined by her own values. We can only be sure of this if we have discussed the issue with her in depth before the decision has to be made.
