Deep sleep v euthanasia: Is there a difference?

Updated on March 18, 2015

French lawmakers voted overwhelmingly on March 17 in favour of a law allowing medics to place terminally ill patients into a deep sleep until they die. 

The law, which has reignited the deeply divisive debate about euthanasia, also makes "living wills" - drafted by people who do not want to be kept alive artificially if they are too ill to decide - legally binding on doctors.

The law was passed by 436 votes to 34 in parliament.

The law would allow doctors to put the patient in general anaesthesia till the moment of death. It is an irreversible state, and opponents say it is no different from euthanasia.

Proponents say it gives patients an option to lessen suffering when they are near death.

While the end result is the same, there are some fine differences in meaning. Here is how they differ.

1. Euthanasia

Euthanasia is defined as the intentional termination of life of an incurably ill person by another to end severe pain or suffering. It is generally done at the request of the patient, but for patients who are in a vegetative state, the explicit wishes of the person may not be known.

It involves a third party and active euthanasia means that the last act was performed intentionally to cause death.

2. Deep sleep

Terminal sedation happens when the patient is placed under strong sedation until he or she dies. This is sometimes called a form of passive euthanasia, or slow euthanasia but while the goal of euthanasia is to shorten life, the main aim of palliative euthanasia is usually to alleviate painful symptoms.

The difference between routine and terminal sedation is that the latter is accompanied with moves such as cutting off other medications and removing a patient's feeding tubes.

Strong painkillers or sedatives can slow breathing and heart rate, and make it impossible for the patient to eat or drink. This may thus hasten death.

However, unlike active euthanasia, the time of death cannot be determined. It is usually impossible to determine if the patient would have lived longer without the drugs.

3. Assisted suicide

The main difference between euthanasia and assisted suicide is that the doctor will provide the patient with information and means of dying, such as lethal drugs, but it is up to the patient to perform the act.

4. Ethical considerations

Those in favour of euthanasia argue for the right of a person to die, and say that there is no harm to others. They also argue for allowing people the choice of when and how to die so as to minimise suffering.

Those against the practice say that one's death does affect others - including one's friends,family and caregivers. Religious leaders believe that the decision of when to die belongs to god.

Some say that euthanasia weakens one's respect for the sanctity of life, and once allowed, may be abused. For example, a patient may feel pressured by people around them to take the option.

Some practitioners argue that proper palliative care makes euthanasia unnecessary.

When it comes to terminal sedation, some justify it using the doctrine of double effect. While death is not desirable, heavy sedation is morally permissible if it achieves good (i.e. relieves pain), even if death is a possible result.

5. Is it legal?

Deep sleep or terminal sedation is legal in the United States and Sweden. Euthanasia is legal in the Netherlands, Belgium, and Luxembourg.

In Singapore, assisted suicide and euthanasia are both not legal. Competent adults can refuse extraordinary life-sustaining medical treatment via an Advanced Medical Directive.

Sources: BBC, New York Times, Time, US Patient Rights Council