Expanding the Use of Continuous Sedation Until Death and Physician-Assisted Suicide.

The article focuses on the debate over the equivalence of continuous sedation until death (CSD) and physician-assisted suicide/euthanasia (PAS/E), arguing that both result in the permanent loss of consciousness and biological death, thus making them functionally equivalent under the criterion of higher brain death. It critiques current clinical protocols for CSD as overly restrictive and clinically centered, limiting patient autonomy and potentially prolonging suffering through incremental titration of sedation. The authors propose two policy changes to enhance patient autonomy: offering CSD as a patient-controlled option upon hospice admission and integrating CSD into PAS/E frameworks for patients meeting PAS/E criteria. These proposals aim to broaden end-of-life options by aligning the administration of CSD more closely with PAS/E, thereby supporting patient-centered care while acknowledging differences in timing and administration between the two practices.