Analgesia, Virtue, and the Principle of Double Effect

Hawryluck, Laura; Harvey, William R.

doi:10.1177/082585970001601s06

Cited by 23 publications

(12 citation statements)

References 31 publications

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“…In the case of terminally ill patients, this problem is different in two ways: (1) terminally ill patients may have developed tolerance, and require doses of opioids that are unsafe for opioid-naive patients; and (2) the risk of aggressive analgesia in terminally ill patients is different from the risk in patients with reversible underlying disease processes. Ethically, if the patient, family, and clinician agree that the primary treatment goal is to provide comfort, the potential risk of an earlier death as a side effect of medications is acceptable (the “double effect” principle) 20. A primary focus of ED care is diagnosis and stabilization.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Experiences of Acutely Symptomatic Patients With Terminal Illness and Their Family Caregivers

Smith

Schonberg

Fisher

et al. 2010

Journal of Pain and Symptom Management

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Context-Despite increased focus on improving palliative care in the emergency department (ED), there is little research on how to best address the specific needs of this patient population. We know little about the experiences of acutely symptomatic patients seen in the ED.Objectives-To better understand the specific needs of this population to improve care of terminally ill patients.Methods-Using in-person semi-structured interviews, we explored the attitudes, experiences, and beliefs of 14 patients and seven family caregivers on the inpatient palliative care consult service who had been admitted through the ED at two academic medical centers. We used a grounded theory approach to code responses. Transcripts were coded by a palliative medicine physician, an emergency medicine physician, and a general internist. Discrepancies were resolved by consensus. Coded sections were iteratively reviewed for interpretation, and concepts were collapsed into themes.Results-Five distinct themes emerged: 1) unprepared for managing symptoms at home; 2) uncertainty and anxiety; 3) communication is essential; 4) mixed experiences with symptom management; and 5) conflicting perspectives about the purpose of palliative care clinicians in the ED. Conclusion-Patients and caregivers identified systems, communication, and clinical issues in EDcare that should be a focus for future research.

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Section: Discussionmentioning

confidence: 99%

Emergency Department Experiences of Acutely Symptomatic Patients With Terminal Illness and Their Family Caregivers

Smith

Schonberg

Fisher

et al. 2010

Journal of Pain and Symptom Management

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“…Ethical management of these symptoms involves balancing symptomatic relief against administration of drugs that might hasten death. The principle of "double effect" recognizes that when treatments intended to relieve suffering incidentally hasten death, ethical principles against killing have not been breached (54). In some countries, intentionally hastening death "for the purpose of relieving suffering" has come to be ethically and legally acceptable (55).…”

Section: Withdrawing Life-sustaining Treatments Double Effect and Hmentioning

confidence: 99%

Ethical controversies at end of life after traumatic brain injury: Defining death and organ donation

Souter

Norman

2010

Critical Care Medicine

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Death is more than a mere biological occurrence. It has important legal, medical, and social ramifications that make it imperative that those who are responsible for determination of death be accurate and above suspicion. The medical and legal definitions of death have evolved to include consideration of such concepts as loss of integration of the whole organism, loss of autonomy, and loss of personhood. Development of the concept of brain death coincided with advances in medical technology that facilitated artificial ventilation and organ transplantation. More recently, the process of "timed" death with subsequent organ donation (controlled donation after cardiac death transplantation) has raised controversial questions having to do with the limits of treatments that facilitate organ transplant but might hasten death, and the duration of cardiac arrest necessary for declaration of death and the commencement of organ procurement. In this review, we discuss the background and ethical ramifications of the concepts of brain death, and of controversies involved in controlled donation after cardiac death organ transplantation.

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“…According to the principle of double effect, an action that has one good (intended) effect and one potentially bad (unintended, but foreseeable) effect is permissible, if the following conditions are met: (1) the action itself must be good or indifferent, with only the good consequences of the action sincerely intended, (2) the good effect must not be produced by the bad effect, and (3) there must be a compelling reason for permitting the foreseeable bad effect to potentially occur 64. This well-vetted approach provides an ethical standard that supports the use of interventions intended to relieve pain and suffering even though there is a foreseeable possibility that death may be hastened 65. In cases in which the child is terminally ill and in severe pain, using large doses of opioids and sedatives to manage pain is justified when no other treatment options are available that would both relieve the pain and make the risk of death less likely 66.…”

Section: Establishing Realistic Goals Of Carementioning

confidence: 99%

The Nursing Dimension of Providing Palliative Care to Children and Adolescents with Cancer

Docherty

Thaxton

Allison

et al. 2012

Clin Med Insights Pediatr

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Palliative care for children and adolescents with cancer includes interventions that focus on the relief of suffering, optimization of function, and improvement of quality of life at any and all stages of disease. This care is most effectively provided by a multidisciplinary team. Nurses perform an integral role on that team by identifying symptoms, providing care coordination, and assuring clear communication. Several basic tenets appear essential to the provision of optimal palliative care. First, palliative care should be administered concurrently with curative therapy beginning at diagnosis and assuming a more significant role at end of life. This treatment approach, recommended by many medical societies, has been associated with numerous benefits including longer survival. Second, realistic, objective goals of care must be developed. A clear understanding of the prognosis by the patient, family, and all members of the medical team is essential to the development of these goals. The pediatric oncology nurse is pivotal in developing these goals and assuring that they are adhered to across all specialties. Third, effective therapies to prevent and relieve the symptoms of suffering must be provided. This can only be accomplished with accurate and repeated assessments. The pediatric oncology nurse is vital in providing these assessments and must possess a working knowledge of the most common symptoms associated with suffering. With a basic understanding of these palliative care principles and competency in the core skills required for this care, the pediatric oncology nurse will optimize quality of life for children and adolescents with cancer.

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Analgesia, Virtue, and the Principle of Double Effect

Cited by 23 publications

References 31 publications

Emergency Department Experiences of Acutely Symptomatic Patients With Terminal Illness and Their Family Caregivers

Emergency Department Experiences of Acutely Symptomatic Patients With Terminal Illness and Their Family Caregivers

Ethical controversies at end of life after traumatic brain injury: Defining death and organ donation

The Nursing Dimension of Providing Palliative Care to Children and Adolescents with Cancer

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