In addition several situations raise specific questions about
the clinical and ethical aspects of CSD. The first one is when a CSD
is requested by patients who are not in terminal phase of their
disease, but are willing to stop treatments necessary to maintain
their vital function, for example to withdraw or withhold a
respiratory mechanical assistance. This occurs not infrequently
in patients with advanced neurological diseases (eg amyotrophic
lateral sclerosis (ALS)), or in persistent vegetative or minimally
conscious state). Also currently such when decision are made
in intensive care units to stop treatments sustaining vital
functions. In such situations, ‘palliative’ sedation - in fact CSD-
, is simultaneously administered in order to prevent suffering,
especially from respiratory distress [9]. Obviously these
decisions result in shortening of life, although not considered as
E/PAS