Paper long abstract:

Over the past couple of decades several countries have issued guidelines for the use of palliative sedation in end of live care. The logic of the guidelines can be summarised in five points. 1) Palliative sedation shall only be used as a last resort, in cases with short expected lifetime and intractable suffering that cannot be relieved in any other way. 2) This requires access to medical and psychological expertise in multiple areas, which among others evaluates the patient's psychological condition and competence to consent. 3) The proportionality principle applies. To ask of a physician to collaborate in the long term or permanent reduction of a patient's consciousness, and therewith life experience, is of such significance that this can only be requested in cases where the patient's suffering is of equal magnitude. 4) Nothing the physician does or does not do shall shorten the patient's life. 5) Everything has to be done to ensure that, in the end, the underlying incurable disease is the cause of death.

Authored by dedicated task forces or standing medical ethical committees, authorized by the respective boards of professional medical associations, and supported of health authorities, the proclaimed value objective of the guidelines is to protect the patient's autonomy - the prime Medical Ethical Principle - and life experience in the face of death. The guidelines are epistemic hybrids, amalgams associating different modes of knowing true from false, right from wrong and legal from illegal.