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Caring for the terminally Ill

P B Bascom1, S W Tolle, C K Cassel

  • 1Division of General Internal Medicine, Oregon Health Sciences University School of Medicine, Portland, USA.

Hospital Practice (1995)
|May 15, 1996
PubMed
Summary

Physicians often hesitate to provide adequate pain relief to dying patients due to fears of hastening death. However, the ethical principle of double effect justifies palliative care for symptom relief, even if it causes respiratory depression.

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Area of Science:

  • Medical Ethics
  • Palliative Care
  • Pain Management

Background:

  • Over 50% of terminally ill patients suffer from inadequate pain and symptom management.
  • Physician reluctance to prescribe high-dose analgesics stems from a fear of causing patient death.

Observation:

  • The ethical principle of double effect is often misunderstood or misapplied in clinical practice.
  • This principle provides a framework for understanding the intended versus unintended consequences of medical interventions.

Findings:

  • Palliative care interventions aimed at relieving suffering are ethically permissible, even if they carry a risk of hastening death.
  • The intention behind prescribing high-dose pain medication is crucial; relief of suffering, not causing death, must be the primary goal.

Implications:

  • Understanding and applying the principle of double effect can improve end-of-life care and patient comfort.
  • Healthcare providers should be educated on the ethical justification of aggressive symptom management in palliative care.
  • This ethical clarity can empower physicians to provide better symptomatic relief to dying patients, improving quality of life.

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