Pravni vjesnik, Vol. 42 No. 2, 2026.
Preliminary communication
https://doi.org/10.25234/pv/33163
BIOETHICAL CONTROVERSIES, LEGAL GUIDELINES AND MORAL DISTINCTIONS CONCERNING PALLIATIVE SEDATION
Ružica Palić Kramarić
; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, Osijek, Croatia
Suzana Vuletić
orcid.org/0000-0002-5629-6635
; Catholic Faculty of Theology in Đakovo, Josip Juraj Strossmayer University of Osijek, Petra Preradovića 17, 31400 Đakovo, Croatia
*
Mato Palić
; Faculty of Law, Josip Juraj Strossmayer University of Osijek, S. Radica 13, 31000 Osijek, Croatia
Tatjana Bačun
; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, Osijek, Croatia
* Corresponding author.
Abstract
Bringing terminal patients' severe chronic pain under control with a view to achieving the greatest possible degree of comfort in palliative care, often requires the use, opioid rotation, dose titration of strong opioids. Their use raises certain bioethical concerns regarding possible recourse to palliative sedation, which, in clinical re/interpretations, may acquire the connotation of “disguised euthanasia”.
Our intention is to present a solid biolegal basis for the view that the administration of strong opioids in cases of unbearable suffering during the final stage of life constitutes the use of ordinary means of treatment, and that certain foreseeable adverse effects may be bioethically tolerated (hypoxia, a state of reduced consciousness, addiction, tolerance, and respiratory depression etc.).
Ethically acceptable criteria and guidelines for decision-making regarding the administration of potentially risky analgesic doses and palliative sedation must be applied with particular regard to the nature of intolerable symptoms, whereby patients and/or their surrogate decision-makers must be adequately informed and must give their consent. The use of strong opioids is governed by the principle of double effect, respect for patient autonomy, including the autonomy exercised through surrogate decision-makers, and the principle of beneficence. Under these principles, the clinician’s intention is justified by the aim of relieving symptoms, rather than by any intention to hasten the death of a terminally ill patient.
If the use of strong sedatives can relieve unbearable pain caused by severe symptoms that have not responded to usual therapeutic interventions, it is clinically reasonable and bioethically correct to use palliative sedation. The moral correctness and certain conditionality of these claims are also affirmed by certain legislative, legal, bioethical and Church documents.
Keywords
Hrčak ID:
349537
URI
Publication date:
19.7.2026.
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