The use of sedation at the end of life is becoming increasingly common, yet its ethics and lawfulness have not been as widely discussed as might have been expected. In this article, the primary focus is on what is known as ‘terminal sedation’, with particular reference to the use of sedation without the provision of assisted nutrition and hydration (‘ANH’). It is argued that, where ANH is not contraindicated by patient wellbeing itself, close scrutiny of the practice is required. There are both ethical and legal reasons why a move towards appropriate regulation is appropriate. The urgency of doing this is evidenced by the variety in practices throughout the world, with some commentators suggesting that the decision whether or not to instigate terminal sedation may be influenced by more than clinical indications for its use (in which case, it may be perilously close to a form of euthanasia). Indeed, it may be argued that there is little that differentiates terminal sedation from a form of euthanasia. Moreover, the relatively common exclusion of existential suffering as an indication for terminal sedation is questioned. Were this also to be accepted as a valid indicator for terminal sedation (without the provision of ANH) it becomes even more urgent that an adequate regulatory framework is developed and that the ethics of the practice are appropriately explored and clarified.

中文翻译：

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镇静剂–良药？良好的道德规范？好的法律？

在生命的尽头使用镇静剂变得越来越普遍，但是其伦理和合法性并未像人们期望的那样得到广泛讨论。在本文中，主要重点是所谓的“终末镇静”，特别是指在不提供辅助营养和水分的情况下使用镇静剂（“ ANH”）。有人认为，如果ANH并未因患者的健康状况而被禁忌，则需要对该行为进行仔细检查。出于适当的监管考虑，从道德和法律上都有理由。全世界的做法多种多样，证明了这样做的紧迫性，一些评论员认为，是否进行终末镇静的决定可能受到使用其临床指征的影响更大（在这种情况下，它可能非常接近安乐死的形式）。确实，可能有人争辩说，几乎没有什么可以区分镇静和安乐死。此外，有人质疑将生存苦难作为终末镇静的指征的相对普遍的排除方法。如果这也被认为是终末镇静的有效指标（不提供ANH），则迫切需要制定适当的监管框架，并适当探索和阐明这种做法的道德规范。