Objective: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide , and explore characteristics of internists who support terminal sedation but not assisted suicide.Design: A statewide, anonymous postal survey.Setting: Connecticut, USA.Participants: 677 Connecticut members of the American College of Physicians.Measurements: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics.Results: 78% of respondents believed that if (...) a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation . Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients and attending religious services more frequently .Conclusions: Support for terminal sedation was widespread in this population of physicians, and most who agreed with terminal sedation did not support PAS. Most internists who support aggressive palliation appear likely to draw an ethical line between terminal sedation and assisted suicide. (shrink)

Through a critical reading of the English decision Ms B v An NHS Hospital Trust, and the more recent Australian decision, Brightwater Care Group v Rossiter, this article examines three fictions that have been crucial in protecting the choice to die in the context of treatment withdrawal whilst maintaining a prohibition on assisting individuals who wish to die. These are: a competent patient can refuse medical treatment for any or no reason, even if it means they will die; the doctor’s (...) removal of life-supporting technology does not entail responsibility for the resulting death; and such deaths are natural deaths. The argument developed here is that when patients and doctors disagree about whether and how death should occur in the treatment withdrawal context, the conceptual space created by law to distance these deaths from culpable deaths is threatened. It is in these moments of dispute that the fictions are challenged, their fragility exposed, and law’s underlying ambivalence about the choice to die revealed. (shrink)