Palliative sedation at the end of life uses and abuses

Linacre Quarterly

Volumn 76, Issue 4, 2009, Pages 390-407

  Pitre, Thomas M ^a  

^a OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 84887421604     PISSN: 00243639     EISSN: None     Source Type: Journal    
DOI: 10.1179/002436309803889034     Document Type: Article

References (26)

1. Natalie Moryl, Nessa Coyle, and Kathleen M. Foley, "Managing an Acute Pain Crisis in a Patient With Advanced Cancer: 'This Is as Much of a Crisis as a Code, '" Journal of the American Medical Association 299. 12(2008):1457-1467.
2. E. J. Cassel, The Nature of Suffering and the Goals of Medicine, 2nd ed. (New York: Oxford University Press, 2004).
3. L. A. Jansen and D. P. Sulmasy, "Proportionality, Terminal Suffering and the Restorative Goals of Medicine", Theoretical Medicine and Bioethics 23(2002):321-337.
4. Charles Bentz, conversation with author, Portland, Oregon, September 2008.
5. See for example, P. Claessens et al., "Palliative Sedation: A Review of the Research Literature", Journal of Pain and Symptom Management 36(2008):310-333.
6. Hospice and Palliative Nurses Association, "Palliative Sedation", position statement, emphasis added, http://www.hpna.org/pdf/ PositionStatement-PalliativeSedation.pdf.
7. T. E. Quill and I. R. Byock, "Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids", Annals of Internal Medicine 132(2000):408-414.
8. P. Rousseau, "Palliative Sedation in the Management of Refractory Symptoms", The Journal of Supportive Oncology 2. 2(2004):181-186.
9. http://ethics.iit.edu/codes/coe/amer.medical.assoc.prin.med.ethics.html.
10. For a commentary on the principle of double effect as it should be properly used in medicine, see D. P Sulmasy and E. D. Pellegrino, "The Rule of Double Effect", Archives of Internal Medicine 159(1999):545-550.
11. T. E. Quill, B. Lo, and D. W. Brock, "Palliative Care Options of Last Resort", Journal of the American Medical Association 278. 33(1997):2099-2104.
12. Jansen and Sulmasy, "Proportionality, Terminal Suffering", 329-330.
13. G. E. M. Anscombe, "War and Murder", in E. A. Wasserman, ed., War and Morality (Belmont, CA: Wadsworth, 1970), 42-53.
14. Rev. Russell J. Smith "Formal and Material Cooperation", Ethics & Medics 20. 6 (June 1995).
15. http://www.vatican.va/roman-curia/congregations/cfaith/documents/ rc-con-cfaith-doc-19800505-euthanasia-en.html.
16. Quill and Byock, "Responding to Intractable Terminal Suffering", 408-409, emphasis added.
17. OHSU Health Care System, Administrative Policy Manual, ch. 7, "Personnel & Human Resources; Conscientious Objection", Adm 07.05. I last reviewed this policy on August 30, 2006.
18. Thomas Finucane, "How Gravely Ill Becomes Dying: A Key to End-of-Life Care", Journal of the American Medical Association 282(1999):1670-1672
19. quotes published data from a large multi-center prospective observational study: SUPPORT Principal Investigators, "A Controlled Trial to Improve Care for Seriously 111 Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT)", Journal of the American Medical Association 274(1995):1591-1598. This study found, using hospice criteria for a "life expectancy of 6 months or less", that 70 percent of patients identified as terminal (in a subgroup of patients with CHF, COPD, and end-stage liver disease) were still alive at 6 months. "As the authors eloquently state, many of these chronically ill patients 'never experience a time during which they are clearly dying of their disease.'" Physicians know how very difficult it is to predict accurately when a patient is going to die, except in the very last stages of their illness. This makes legislative efforts like AB 2747 with provisions of "up to one year to live", as originally drafted, extremely dangerous.
20. J. Legemaate et al., "Palliative Sedation in the Netherlands: Starting-Points and Contents of a National Guideline", European Journal of Health Law 14(2007):61-73.
21. J. Rietjens et al. "Continuous Deep Sedation for Patients Nearing Death in the Netherlands: Descriptive Study", British Medical Journal 336(2008):810-813.
22. Rousseau, "Palliative Sedation", 183.
23. http://www.pccef.org.
24. http://www.take-the-pledge.com/take-the-pledge.htm?step= 3&country=US&utid=1.
25. http://www.supportivecarecoalition.org.
26. http://www.marthamaryministries.org.