The Dutch Medical Association has issued new guidance on palliative sedation, acknowledging that the practice, increasing in the Netherlands, is more “unmanageable” than it could have foreseen.

The association accepts that its original 2005 guideline failed to properly address concerns about its possible inappropriate use. Some lay people were especially worried about the deep and continuous sedation of terminally ill patients until death.

Fears were raised among people outside the medical profession that doctors could opt for this to avoid the legal requirements to report euthanasia (BMJ 2007;334:1075, doi:10.1136/bmj.39220.590428.DB).

Marian Verkerk, who chairs the guidelines committee and is professor of medical ethics at Groningen University Medical Centre, accepts …