Abstract
Sedation, understood from the medical perspective as: the administration of drugs to lessen the patient’s level of consciousness, with the objective of controlling some of the symptoms or to prepare the patient for a diagnostic or therapeutic intervention that could be stressful or painful (Comité de Ética 2002). It is described as “palliative” when such an administration is done to “lessen the patient’s level of consciousness with the objective of controlling physical or psychical symptoms or both”, which can equate to a primary sedation: to reduce the level of consciousness in a patient with an advanced or terminal illness, as much as it is necessary to adequately alleviate one or more refractory symptoms and according to the patient’s explicit, implicit or delegated consent; or terminal sedation, which implies the: deliberate administration of drugs to achieve relief, unachievable in any other way, of a physical or psychic pain, or both, through the sufficiently deep and foreseeably irreversible lessening of consciousness in a patient close to death and with the patient’s explicit, implicit or delegated consent (Santos et al. 2009).
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Notes
- 1.
«Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. »: Preamble to the Constitution of the World Health Organization, adopted by the International Health Conference, New York, 19th June to 22nd July, and entered into force on the 7th April 1948.
- 2.
This implies, for example, to recognize “an equitable access to palliative care for all terminally ill or dying persons” (Recommendation 1418 (1999), of the 25th June, European Council Parliamentary Assembly, on the Protection of the human rights and dignity of the terminally ill and the dying, Section 9.A.II).
- 3.
It has to be taken into account that our jurisprudence has also considered the appropriateness of the withholding of treatment in the case of patients under age (Vivanco 2002).
- 4.
In the case of Chile, from the middle of the nineteen nineties there are the beginnings of jurisprudence, in the sense that the patient cannot be forced to accept a therapeutic measure on the basis that no-one can be forced to defend his/her own rights, v.g. The judgment from the Corte de Apelaciones de Santiago [Court of Appeal in Santiago] in Autos Rol Nº 806-96 [Record number 806-96] Hospital San José against J.C. rejected the protective injunction lodged by that Hospital to force the patient to have a transfusion saying that the lodged injunction has to protect the life of a person who is disturbed or threatened by the action of a third party, but cannot pursue the protection against the voluntary omission of a person to save their life, because no-one can be forced to defend his/her own right. In the same way, in 2001 the Corte de Apelaciones de Talca [Court of Appeal in Talca] in Autos Rol Nº 60069-01, declared inadmissible the protective injunction in the same vein, considering that taking into account the background it can be implied that the person in favor and against is the same one, therefore, the injunction is declared inadmissible. Later, the court recognized the right to reject medical treatments on the part of a competent patient, when a statement is filed of such decision: v.g. Sentencia de la Corte de Apelaciones de San Miguel en Autos Rol Nº 104 2008: [the Appeal Court in San Miguel, Record Number 104-2008] [Fourteenth]: that as a consequence, in the cases of prescription of therapeutic treatments on the part of a medical doctor regarding a patient, who in a fully competent state of physical and mental faculties, resolves to reject the treatment, whether because they believe it will produce a therapeutic deterioration or because the patient considers that they will be deprived of the conditions of life that they consider essential and minimal, the affected guarantee would not necessarily be the right to life. Indeed, in this situation two different opposing interests will be in conflict over the same fundamental right. From the perspective of the sentencing tribunals, the freedom of conscience between two subjects becomes contradictory, first the right of the patient required to have a curative procedure, and secondly, the freedom of conscience of the medical doctors who offer that procedure and who in carrying it out are fulfilling their duty of looking after the health and life of the persons in their charge. Fifteenth: that when facing a bioethical conflict of this nature, the doctrine has orientated in the sense to recognize that in the adult individual, in full possession of his physical and mental faculties, the prerogative of opposing therapeutic treatment when considered extreme or unbearable, or because it can damage, in that individual’s appreciation, aspects that constitute essential elements of life and of its quality…/ Sixteenth : that in the terms described, it is important to analyze the degree of freedom and independence in the decision adopted by Mr. L.S.G. – if in reality there has been – and if when it was adopted, he/she acted in full knowledge of it, and in particular of its consequences. Nineteenth: that as a consequence the sentencing tribunals have not acquired the indispensable and essential conviction that Mr. L.S.G., in full use and exercise of his physical and mental faculties, has rejected the prescribed therapeutic treatment./ Twentieth: that, on the other hand, according to the medical records attached to the appeal, there is certainty, that without the recommended surgical operation, Mr. L.S.G. will die in a short period of time./ Twenty-first: that the conflict between the protected right to freedom of conscience and the right to life, having been elucidated as has been done in the preceding reasoning, these sentencing tribunals will opt to protect the constitutional guarantee of the right to life as it is protected in Article 19, No.1 of the Chilean State Constitution, in the terms that are allowed by Article 20 of the same document … and therefore, the medical doctors of this health service are authorized to carry out the necessary procedures to preserve his life and prompt recovery, including surgical operations required for such effect.
- 5.
…the faculty that a competent person has to reject medical treatment, even when they are vital, has to be clearly distinguished from direct collaboration in causing death, because in one case, it is about a decision proper to the parity currently recognized in the medical doctor-patient relationship and of the value of the principle of quality of life when the treatments are onerous, out of proportion or useless, while in the other case, there is an action directly taken to cause death in the individual (Vivanco 2002).
- 6.
In some legal systems, it has been recognized as a medical doctor’s obligation to respect the patient’s decisions and avoid forced treatment: in Article 2.6 of the Law 41/2002, of the 14th November, basic regulator of the patient’s autonomy and the rights and obligations in terms of information and clinical documentation (BOE No. 274, dated 15.11.2002) in Spain, expresses: Any professional who intervenes in the assistant activity is obliged not only to the correct rendering of his technical capacities, but also to fulfill the duties of information and clinical documentation, and to respect the free and voluntary decisions adopted by the patient.
- 7.
The law obtained the approval of Tribunal Constitucional (Constitucional Court) on year 2012 for it to be enacted as law for the República de Chile [Republic of Chile].
- 8.
Bold characters are ours.
- 9.
Idem.
- 10.
Idem.
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Vivanco, A. (2015). Palliative Sedation: Some Legal Precautions in the Case of Chile. In: Taboada, P. (eds) Sedation at the End-of-life: An Interdisciplinary Approach. Philosophy and Medicine(), vol 116. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-9106-9_8
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