Deep sedation is occasionally the only effective treatment for refractory symptoms and suffering in terminally ill patients. In their accompanying study, Rietjens and colleagues report a significant rise in continuous deep sedation in the Netherlands from 5.6% in 2001 to 7.1% in 2005, while cases of euthanasia declined over the same period.1

Continuous deep sedation is an accepted treatment in the Netherlands for patients whose life expectancy is two weeks or less. The Dutch study reports that 1200 fewer people died as a result of euthanasia but 1800 more died as a result of terminal sedation in 2005 than in 2001. Although the increase follows the publication in 2002 of guidelines for general practitioners on the use of continuous deep sedation, and attention in the Dutch media, the cause of this trend is unclear. There is concern that continuous deep sedation may enable doctors to evade the procedural requirements for euthanasia. In the Dutch study, 9% of deaths during continuous sedation were preceded by a euthanasia …