Article Text

Download PDFPDF
Expanded terminal sedation: too removed from real-world practice
  1. Guy Schofield1,2,
  2. Idris Baker3,4
  1. 1 Department of Oncology and Palliative Medicine, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Centre for Ethics in Medicine, University of Bristol, Bristol, UK
  3. 3 Department of Palliative Medicine, Swansea Bay University Health Board, Port Talbot, UK
  4. 4 Swansea University Medical School, Swansea, UK
  1. Correspondence to Dr Guy Schofield, Imperial College Healthcare NHS Trust, London, UK; guy.schofield{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Gilbertson et al present a considered analysis of the abstract problem of ‘sedation’ at the end of life,1 and it is reassuring to see the separation of multiple practises that are often grouped under the heading terminal sedation. In their work, the authors attempt to introduce and justify a new practice in the care of those dying with significant suffering—expanded terminal sedation (ETS).

This analysis will not, however, help our colleagues at the bedside. Here, we will focus on the flaws which are most relevant to clinicians: jurisdiction, uncertainty and reversibility.

The authors’ focus on a jurisdiction that does already allow medically assisted in dying confuses their analysis. For example, either an instance of their proposed ETS does amount to intentionally hastening death, in which case it should be treated as a means of euthanasia and practised only where that is permitted, subject to its limits and regulations; or it does not amount to intentionally hastening death, in which case there is no reason to specify such jurisdictions. To explain that the most controversial elements of terminal sedation have been tacitly ‘accepted’ by the society in question does not invalidate the concerns. It is beyond the scope of this response to explore these, but to us, …

View Full Text


  • Twitter @DrGuySchofield, @BakerIdris

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

Linked Articles

  • Feature article
    Laura Gilbertson Julian Savulescu Justin Oakley Dominic Wilkinson

Other content recommended for you