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Expanding choice at the end of life
  1. Dominic Wilkinson1,2,3,4,
  2. Laura Gilbertson5,
  3. Justin Oakley5,
  4. Julian Savulescu1,3,4
  1. 1Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
  2. 2Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  4. 4Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  5. 5Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Professor Dominic Wilkinson, University of Oxford, Oxford, UK; dominic.wilkinson{at}

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We are grateful to the commentators on our article1 for their thoughtful engagement with the ethical and clinical complexity of expanded terminal sedation (ETS) in end-of-life care. We will start by noting some points of common ground, before moving on to the more challenging ways in which TS might be permissibly expanded.

First, several commentators pointed out, and we completely concur, that it is important to provide patients with full information about their end-of-life options, including the ‘outcomes, uncertainties and costs of ETS’.2 Where possible, they should be given time to ‘process their feelings and to reflect on how they wish to live in their last few days, weeks or months’.3 Furthermore, where patients receive sedation, it will be critical that they receive appropriate medical and nursing care to prevent physical complications such as pressure ulcers.2 This would be no different from other patients who are in states of reduced consciousness from disease.

We acknowledge that there are heightened risks with earlier and more rapid TS, including the potential loss of spiritual and social moments,4 as well as the meaning that can be derived from conscious existential distress.3 However, while these conscious experiences might be valuable to some, others might weigh them less highly against the foreseen …

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  • Funding This research was funded in whole, or in part, by the Wellcome Trust (203132/Z/16/Z).

  • Disclaimer The funders had no role in the preparation of this manuscript or the decision to submit for publication. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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