The Rule of Double Effect — A Critique of Its Role in End-of-Life Decision Making

Quill, Timothy E.; Dresser, Rebecca; Brock, Dan W.

doi:10.1056/nejm199712113372413

Cited by 288 publications

(100 citation statements)

References 26 publications

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“…At the same time, the patient's beliefs, values, and preferences for end-of-life care can be explored. It has been argued that the principle of double effect is philosophically untenable because clinical intentions, like all human intentions, are complex, ambiguous, and often contradictory [4]. While the complexity and ambiguity of human intentions is not disputed, the principle remains a crucial tool for clinical decision making for physicians unwilling either to perform or openly condone euthanasia, or to let their patients suffer.…”

Section: The Principle Of Double Effectmentioning

confidence: 99%

“…Its applicability to end-of-life decision making is widely accepted and has been reaffirmed recently by Pope John Paul II [3]. The principle states that an action with two or more possible effects, including at least one possible good effect and others that are bad, is morally permissible if four provisos are met [4,5]:…”

Section: The Principle Of Double Effectmentioning

confidence: 99%

“…Various arguments have appeared recently against SIDD Pat as an instance of the principle of double effect and against SIDD Pat in general [4,6] [7,[12][13][14]. The best study to date by Chater and colleagues surveyed 61 palliative care experts of whom 89% felt that "terminal sedation" was sometimes necessary and 77% had used "terminal sedation" within the preceding year [8].…”

Section: Sedation For Intractable Distress Of a Dying Patient (Sidd Pat)mentioning

confidence: 99%

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Sedation for Intractable Distress of a Dying Patient: Acute Palliative Care and the Principle of Double Effect

et al. 2000

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Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The case presented is of a young man dying of recurrent epithelioid hemangioendothelioma, distressed with stridor and severe pain, whose poorly controlled symptoms were successfully treated with an infusion of propofol, titrated to provide effective comfort in the last few hours of the patient's life. The tenet of double effect, which allows aggressive treatment of suffering in spite of foreseeable but unintended consequences, is reviewed. The patient's parents were invited and contributed to the Rounds, providing compelling testimony to the power of the presence of clinicians at the time of death and the importance of open communication about difficult ethical issues.

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Section: The Principle Of Double Effectmentioning

confidence: 99%

Section: The Principle Of Double Effectmentioning

confidence: 99%

Section: Sedation For Intractable Distress Of a Dying Patient (Sidd Pat)mentioning

confidence: 99%

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Sedation for Intractable Distress of a Dying Patient: Acute Palliative Care and the Principle of Double Effect

et al. 2000

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“…Under the principle of double effect, as long as the provider has the intent of preventing ovulation or conception, prescribing or giving a victim an emergency contraceptive is permissible even with the foreknowledge that it might instead cause rejection of a fertilized ovum. 43 Some Catholic organizations have adopted more dogmatic positions. The Pennsylvania Catholic Conference, for example, stated that although conception may be avoided, use of any "medical procedure, the purpose and/or effect of which is abortive, is never permissible."…”

Section: Ethical Considerations In the Treatment Of Rape Victimsmentioning

confidence: 99%

Informed consent for emergency contraception: variability in hospital care of rape victims

Smugar¹,

Spina²,

Merz³

2000

Am J Public Health

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There is growing concern that rape victims are not provided with emergency contraceptives in many hospital emergency rooms, particularly in Catholic hospitals. In a small pilot study, we examined policies and practices relating to providing information, prescriptions, and pregnancy prophylaxis in emergency rooms. We held structured telephone interviews with emergency department personnel in 58 large urban hospitals, including 28 Catholic hospitals, from across the United States. Our results showed that some Catholic hospitals have policies that prohibit the discussion of emergency contraceptives with rape victims, and in some of these hospitals, a victim would learn about the treatment only by asking. Such policies and practices are contrary to Catholic teaching. More seriously, they undermine a victim's right to information about her treatment options and jeopardize physicians' fiduciary responsibility to act in their patients' best interests. We suggest that institutions must reevaluate their restrictive policies. If they fail to do so, we believe that state legislation requiring hospitals to meet the standard of care for treatment of rape victims is appropriate.

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“…When facing these decisions, palliative medicine physicians often cite the doctrine of double effect in PS practice. 19,22,23 The doctrine of double effect is grounded in the ethical principle of proportionality. It originated from Thomas Aquinas in the 13th century.…”

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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The Rule of Double Effect — A Critique of Its Role in End-of-Life Decision Making

Cited by 288 publications

References 26 publications

Sedation for Intractable Distress of a Dying Patient: Acute Palliative Care and the Principle of Double Effect

Sedation for Intractable Distress of a Dying Patient: Acute Palliative Care and the Principle of Double Effect

Informed consent for emergency contraception: variability in hospital care of rape victims

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

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