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Objective: To collect medical-ethical arguments for and against the practice of terminal sedation in mentally-competent patients., Design: Literature search., Method: Medical-ethical arguments for and against the practice of terminal sedation were sought in electronic databases, for example Pubmed, Medline, and the Netherlands Institute for Scientific Information Services. The arguments found can help in making a well-considered and careful decision., Results: Terminal sedation can be defined as deliberately inducing and maintaining deep sleep in terminally-ill patients with recalcitrant symptoms, by using high doses of sedatives but without the intention of hastening death. Arguments in favour of this approach included: good care provision, useful medical procedure, autonomy of the patient, the doctrine of the double effect and an alternative for euthanasia and assisted suicide. Arguments against included: impossible to communicate due to sedation, responsibility for unintended consequences, shortening the length of life, religious and cultural objections, incompetence, abuse by the care-provider or the patient and the interest of the physician., Conclusion: In the literature no overriding moral objections to the use of terminal sedation were found. This palliative option may be regarded as a useful addition to the existing range of interventions. Although it can never be excluded, abuse is not a decisive factor. There seems to be a need for a guideline with meticulous criteria and procedures that promotes the responsible use of this intervention.

This article describes the clinical history of a woman aged 75 with a pseudolymphoma syndrome that was probably a consequence of the use of carbamazepine. This syndrome is characterised by lymphadenopathy, fever and a generalised rash. These signs can easily be confused with the existence of a true malignant T-cell lymphoma or Hodgkin's disease. Chemotherapy may be given to these patients if this adverse reaction, which mimicks a true malignant lymphoma, is not recognised. After withdrawal of the drug the symptoms disappear mostly in a few days.