Medical Ethics and Double effect: The Case of Terminal Sedation

Boyle, Joseph

doi:10.1023/b:meta.0000025096.25317.22

Cited by 79 publications

(47 citation statements)

References 5 publications

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“…Es claro, sin embargo, que la sola existencia de detractores del PDE no es un argumento contra su validez. Por lo demás, son muchos también sus partidarios, como Anscombe 2 , Finnis 3 , Boyle 4 , Cavanaugh 5 , Kaczor 6 o, pace Figueroa, la propia Foot, que terminó por aceptar la relevancia moral de la distinción intentado/colateral 7 . En realidad, Figueroa presenta sólo un argumento contra el PDE.…”

Section: Respuesta Al Argumento De Thomsonunclassified

Eutanasia, suicidio asistido y principio del doble efecto: Réplica al profesor Rodolfo Figueroa

Montecinos

2012

Rev. méd. Chile

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The reason for this difference is that, in the fi rst two cases, the patient's death is intended as a means of pain relief; whereas, in the latter two, death is only a side effect of a medical act, an act justifi able if it is necessary to achieve a proportionate good. In a recent issue of this Journal, Professor Rodolfo Figueroa denied the soundness of the principle of double effect and maintained that all actions describedabove should be considered equivalent in law enforcement. Here, the author presents a reply to that argument, and also offers a justifi cation of the afore said principle's core, that is, the moral and legal relevance of the distinction between intended effects and foreseen side effects. (Rev Med Chile 2012; 140: 261-265).

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Section: Respuesta Al Argumento De Thomsonunclassified

Eutanasia, suicidio asistido y principio del doble efecto: Réplica al profesor Rodolfo Figueroa

Montecinos

2012

Rev. méd. Chile

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“…Those conditions include that the action (sedation) is morally good or neutral, the undesired outcome (loss of interactional function and potentially hastened death) is not directly intended, the desired effect is not necessarily a direct result of the unintended negative result (in other words that symptom relief can be achieved without the death of the patient), and that the good effect is proportional to the negative effect. 24 refuSAl of Anh during pS Another important ethical tension surfaces with the decision of whether to continue ANH during PS. Some may conclude that PS requires administration of ANH because the patient cannot eat or drink.…”

Section: Ethical Issuesmentioning

confidence: 99%

Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments

Olsen

Swetz

Mueller³

2010

Mayo Clinic Proceedings

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Palliative sedation (PS) is the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. Although uncommon, some patients undergoing aggressive symptom control measures still have severe suffering from underlying disease or therapy-related adverse effects. In these circumstances, use of PS is considered. Although the goal is to provide relief in an ethically acceptable way to the patient, family, and health care team, health care professionals often voice concerns whether such treatment is necessary or whether such treatment equates to physician-assisted suicide or euthanasia. In this review, we frame clinical scenarios in which PS may be considered, summarize the ethical underpinnings of the practice, and further differentiate PS from other forms of end-of-life care, including withholding and/or withdrawing life-sustaining therapy and physician-assisted suicide and euthanasia. © 2010 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) P alliative sedation (PS) refers to the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. The practice of PS has gained attention in the literature during the past 20 years. In 1994, Cherny and Portenoy 1 first offered an algorithm for determining appropriate indications for use of PS. During the late 1990s, several important court cases in the United States brought the issue of PS to the forefront and clarified the legality of the right to palliation at end of life. 2,3 Studies have shown that PS is effective, with efficacy rates ranging from 71% to 92%, 4 usually defined as the patient, family, or physician's perceived relief of refractory physical symptoms. In many settings, PS is uncommon, although a recent review revealed considerable variability in the prevalence of PS in the United States and other countries. 4 When PS is used, it is a measure of last resort rather than general care. Although required infrequently, PS is an important palliative tool with which clinicians should be familiar. PrActIcAl ISSueSThe following sections explore issues of the application of PS. Detailed guidelines for practicing PS, although beyond the scope of this article, have been published. 5

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“…Durante las últimas décadas se han hecho importantes contribuciones al análisis de los fundamentos ético-antropológicos de la SP (2)(3)(4)(5)(6)(7)(8). Entre los criterios éticos que se han propuesto para fundamentar la legitimidad ética de la SP se encuentran, entre otros(2-8):…”

Section: Introductionunclassified

“…El uso de fármacos que alteran el estado de vigilia de los pacientes -como los sedantes y/o los opioides-en ocasiones genera dudas éticas en el equipo de salud y/o en el paciente y su familia (2)(3)(4)(5)(6)(7)(8). Se teme que los efectos adversos asociados al uso de este tipo de fármacos -como son la hipotensión, la depresión respiratoria, la pérdida del uso de la facultades superiores, etc.-puedan representar una forma de eutanasia (2)(3)(4)(5)(6)(7)(8).…”

Section: Introductionunclassified

Sedación paliativa (parte II): Cuestiones éticas y principios morales

Taboada

2014

Acta bioeth.

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Resumen: El artículo analiza algunas cuestiones éticas debatidas actualmente en relación con el uso de la sedación al final de la vida, tales como: 1. Si existe una diferencia éticamente relevante entre la sedación paliativa y la eutanasia o el suicidio médicamente asistido; 2. Si el principio del doble efecto tiene aplicación para justificar el recurso a la sedación al final de la vida; 3. Si la sedación paliativa puede ser éticamente apropiada para pacientes que no están en etapa de agonía; 4. Si las decisiones de suspender hidratación y/o nutrición médicamente asistidas son condición necesaria para indicar la sedación; 5. Si la sedación es una respuesta apropiada para el manejo de síntomas psicoespirituales, incluyendo el sufrimiento existencial; 6. Si se puede utilizar la sedación en pacientes incompetentes (i.e. personas incapaces de prestar su consentimiento informado). Para cada una de estas interrogantes se propone una reflexión ético-antropológica, haciendo referencia a algunos principios éticos generales, como la inviolabilidad de la vida humana, el respeto por la dignidad de los moribundos, el principio terapéutico y la proporcionalidad en las terapias, el principio del doble efecto, el respeto por el ejercicio responsable de la libertad (autonomía) y la justicia y la solidaridad.Palabras clave: cuidados paliativos, sedación profunda, cuidados terminales, cuidados hospitalarios, eutanasia Palliative Sedation (Part II). Ethical questions and moral principlesAbstract: This article analyzes some of the most controversial ethical questions related to the use of sedation at the end-oflife. Among these questions are: 1. Whether there is an ethically relevant difference between Palliative Sedation (PS) and euthanasia and physician-assisted-suicide; 2. Whether the principle of double effect can be appropriately applied to justify the use of sedation at the end-of-life; 3. Whether PS might be ethically acceptable in the case of patients that are not imminently dying (agony); 4. Whether decisions to limit care and to withdraw medically assisted nutrition and hydration are a necessary condition for PS; 5. Whether sedation is an adequate response to psycho-spiritual symptoms, including 'existential suffering'; 6. Whether sedation could be used in patients who are not able to give their informed consent (e.g. patients with cognitive impairment of diverse origins). Ethical-and anthropological reflections are proposed for each of these questions. Reference to some general ethical principles is made, such us: the inviolability of human life; respect for the dignity of the dying; the therapeutic principle and proportionality in medical care; the principle of double effect; respect for a responsible exercise of freedom (autonomy); justice and solidarity.Key words: palliative care, deep sedation, terminal care, hospice care, euthanasia Sedação paliativa (parte II). Questões éticas e princípios moraisResumo: O artigo analisa algumas questões éticas debatidas atualmente com relação ao uso da sedação no final da vida, tais...

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Medical Ethics and Double effect: The Case of Terminal Sedation

Cited by 79 publications

References 5 publications

Eutanasia, suicidio asistido y principio del doble efecto: Réplica al profesor Rodolfo Figueroa

Eutanasia, suicidio asistido y principio del doble efecto: Réplica al profesor Rodolfo Figueroa

Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments

Sedación paliativa (parte II): Cuestiones éticas y principios morales

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