Continuous sedation until death (CSD) is a rapidly
developing practice in several countries, including Belgium and
the Netherland where euthanasia/physician-assisted-suicide
(E/PAS) is legalized [1]. Surveys in the Netherland tended to
show a decrease in the number of voluntary euthanasia, with
a simultaneous rise of CSD [2]. The ‘UNBIASED’ study in UK,
Belgium and the Netherland following death of adult cancer
patients who had received CSD found that Dutch and Belgian
physician and nurses often positioned CSD as an alternative to
euthanasia, allowing a ‘natural death’ while UK interviewees
placed emphasis on the medical management of symptoms [3].
Considering CSD as an equivalence to a natural death was first
questioned by Seymour et al. [4] who argued that sedation just
mimics it, allowing to consider it as a ‘good death’. For Raus
et al. [1] such simulation of a natural death, including a deep
sleep, with fading away peacefully, and dying from internal
causes without prolonging or shortening life, is fundamentally
wrong: CSD is a medically provoked coma, and the frequent
associated decision to forego administration of food and fluids
may contribute to shorten life. Actually CSD might be felt more
acceptable altogether by the carers, the patients and the families,
because less rapid than E/PAS, but, on the other side