Continuous sedation until death (CSD) is a rapidly developing
practice in several countries, appearing as more acceptable than
euthanasia/physician-assisted-suicide, since more close to a
‘natural death’. The French parliament is going to adopt soon a law
recommending CSD on request of the patient, along with forgoing
artificial feeding and hydration. France will have thus a unique
international position for end-of-life care.
Yet many ethical problems raised by CSD, in which psychosocial
death preceeds the biological death, have already been raised
in the literature. The legitimacy of CSD, especially if deep and not
proportionate, is questioned in case of existential distress. The
primacy given to autonomy is questionable for vulnerable patients
who deserve mainly a social solidarity. The double effect principle
is replaced by a co-intention, putting CSD in a grey zone between
palliation and euthanasia.