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Palliative sedation: not just normal medical practice. Ethical reflections on the Royal Dutch Medical Association's guideline on palliative sedation
  1. Rien Janssens1,
  2. Johannes J M van Delden2,
  3. Guy A M Widdershoven
  1. 1Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
  2. 2Julius Center for Health Sciences, University Medical Center, Utrecht, Netherlands
  1. Correspondence to Dr Rien Janssens, Department of Medical Humanities, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands; mjpa.janssens{at}


The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation.

First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline.

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