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ACP-ASIM Pressroom

CONTACT: Susan Anderson, 215-351-2653 or 800-523-1546, ext. 2653

Terminal Sedation and Refusal of Food and Fluids at End of Life

—Last-Resort Responses to Intolerable Suffering

Despite excellent care at the end of life, a few patients still experience extreme and intolerable suffering. A new paper by the End-of-Life Care Consensus Panel of the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) explores two options that physicians and patients sometimes consider in these exceptional cases: terminal sedation and voluntary refusal of food and fluids.

The paper defines the practices, distinguishes them from standard palliative care and from physician-assisted suicide, gives guidance on the conditions under which they can be considered, and shows how to make decisions in these cases. It explores the moral and legal status of the practices and stresses the requirement that the suffering cannot be relieved by other means.

The paper concludes that "terminal sedation and voluntary refusal of food and fluids are imperfect but useful last-resort options. Patients and their families who fear that physicians will not respond to extreme suffering will be reassured when such options are predictably made available."

The paper was written by Timothy E. Quill, MD, associate chief of medicine at Genesee Hospital in Rochester, N.Y., and Ira R. Byock, MD, director of the Palliative Care Service in Missoula, Mont. for the ACP-ASIM End-of-Life Care Consensus Panel. ACP-ASIM convened this panel of experts on end-of-life care in 1997 to develop ethical, policy and clinical recommendations that, if adopted, will lead to demonstrably better care at the end of life. The papers provide guidance to physicians caring for dying patients and are also useful for patients and families. To date, four other papers have been published and are available on the ACP-ASIM Web site (www.acponline.org/ethics).
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NOTE TO EDITORS: For copies of the paper, "Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids," please call Penny Fuller at 1-215-351-2656 or 1-800-523-1546, ext. 2656. For an interview with Dr. Byock, please call Susan Anderson at 1-215-351-2653 or 1-800-523-1546, ext. 2653.

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