ABSTRACT
One way of exercising one's right to determine the manner and time of one's own death is by requesting palliative care or palliative sedation, in particular deep sedation that is meant to continue until the end of one's life. The chapters in this part discuss the proper aims of these practices and the conditions of their legitimacy.
The alleviation of suffering is traditionally considered one of the main aims of medicine. According to Eric Cassell, suffering is “a specific state of severe distress related to the imminent, perceived or actual, threat to the integrity or existential continuity of the person”. This means that suffering has a cognitive element: it implies the belief that one's personhood is fundamentally threatened. Suffering is a complex whole of negative emotions that similarly have cognitive elements of their own.
By now there exists an extensive empirical literature listing the elements of suffering at the end of life. In this literature, all the elements of suffering besides pain and other physical symptoms are understood as ‘non-physiological symptoms’. The lists are instruments for diagnosis, ideally to be followed by therapy. This purely functional approach fails to recognize the cognitive aspect of all emotions, including the negative ones: they are all more or less adequate responses to the situation the person finds herself in. The same is true of suffering as an overall response to that situation. These responses should be the object of reflection and of dialogue rather than of diagnosis and therapy. We should normally want to improve their quality, not to get rid of them.
