scholarly journals La sedazione palliativa tra etica e diritto: la situazione italiana

2013 ◽  
Vol 62 (1) ◽  
Author(s):  
Fabio Persano
Keyword(s):  
Palliative Care ◽  
Pain Therapy ◽  
Ethical Issues ◽  
Double Effect ◽  
Palliative Sedation ◽  
University Hospital ◽  
Allo Scopo ◽  
Traditional Concept ◽  
Principle Of Double Effect ◽  
The University

In materia di Legge 38/2010 sulle cure palliative e la terapia del dolore, va segnalato il fatto che il legislatore non ha preso esplicitamente posizione riguardo alla sedazione terminale. Questa pratica (che consiste nella riduzione intenzionale della vigilanza con mezzi farmacologici, fino alla perdita della coscienza, allo scopo di ridurre o abolire la percezione di un sintomo – altrimenti intollerabile per il paziente – nonostante siano stati messi in opera i mezzi più adeguati per il controllo del sintomo, che risulta, quindi, refrattario) presenta due importanti problemi etici, consistenti nella necessaria soppressione della coscienza e nel possibile abbreviamento della vita del malato. La soluzione proposta dalla bioetica personalista (l’applicazione del principio del duplice effetto, per il quale un atto è etico anche se da esso ne consegue pure un male non voluto, a determinate condizioni) viene qui riproposta ed eletta a soluzione plausibile anche sul piano giuridico, attraverso una correzione del tradizionale concetto penalistico di dolo. L’articolo è arricchito da ampi riferimenti alle linee guida della Società Italiana di Cure Palliative e contiene le raccomandazioni per la pratica clinica della sedazione terminale elaborate dal Policlinico Gemelli di Roma. ---------- With reference to the Law 38/2010 on palliative care and pain therapy, it should be noted that the legislature has not adopted a position about the palliative sedation. This practice (which consists of the intentional reduction of vigilance up to unconsciousness by pharmacological means, to reduce or abolish the perception of a symptom – otherwise intolerable for the patient – even though the most appropriate means have used for the control of the symptom, which is, therefore, refractory) raises two important ethical issues, that concern the necessary suppression of consciousness and the abbreviation of life. The solution of the Personalistic Bioethics (the application of the principle of double effect, for which an act is ethical even if it causes unintended evils, under certain conditions) is here reproposed, presenting it as plausible solution also for the legal level, through a correction of the traditional concept of malice. Furthermore, the article includes extensive references to the guidelines of the Italian Society of Palliative Care as well as to recommendations of the University Hospital “A. Gemelli” of Rome on terminal sedation

Ethical end-of-life palliative care: response to Riisfeldt

2019 ◽  
Vol 46 (1) ◽  
pp. 51-52 ◽  
Author(s):  
Heidi Giebel
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Human Life ◽  
Double Effect ◽  
Palliative Sedation ◽  
Life Care ◽  
Intrinsic Properties ◽  
Principle Of Double Effect ◽  
Care Response

In a recent article, 1 Riisfeldt attempts to show that the principle of double effect (PDE) is unsound as an ethical principle and problematic in its application to palliative opioid and sedative use in end-of-life care. Specifically, he claims that (1) routine, non-lethal opioid and sedative administration may be “intrinsically bad” by PDE’s standards, (2) continuous deep palliative sedation (or “terminal sedation”) should be treated as a bad effect akin to death for purposes of PDE, (3) PDE cannot coherently be applied in cases where death “indirectly” furthers an agent’s intended end of pain relief via medically appropriate palliative care, and (4) application of PDE requires sacrificing common beliefs about the sanctity of human life. I respond by showing that Riisfeldt’s understanding of PDE is seriously mistaken: he misattributes Kantian and Millian reasoning to the principle and conflates acts’ intrinsic properties with their effects. Further, a corrected understanding of PDE can address Riisfeldt’s case-specific objections.

A response to critics: weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation

2019 ◽  
Vol 46 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Thomas D Riisfeldt
Keyword(s):  
Palliative Care ◽  
Human Life ◽  
Double Effect ◽  
Palliative Sedation ◽  
Care Provision ◽  
Doctrine Of Double Effect ◽  
Opioid Use ◽  
Category Mistake ◽  
Original Argument ◽  
Cherry Picking

My essay ‘Weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation’ has recently generated some critique which I will attempt to address in this response. Regarding the empirical question of whether palliative opioid and sedative use shorten survival time, Schofield et al raise the three concerns that my literature review contains a cherry-picking bias through focusing solely on the palliative care population, that continuous deep palliative sedation falls beyond the scope of routine palliative care, and that my research may contribute to opiophobia and be harmful to palliative care provision globally. Materstvedt argues that euthanasia ‘ends’ rather than ‘relieves’ suffering and is not a treatment, and that the arguments in my essay are therefore predicated on a ‘category mistake’ and are a non-starter. Symons and Giebel both raise the concern that my Kantian and Millian interpretation of the Doctrine of Double Effect is anachronistic, and that when interpreted from the contemporaneous perspective of Aquinas it is a sound ethical principle. Giebel also argues that palliative opioid and sedative use do meet the Doctrine of Double Effect’s four criteria on this Thomistic account, and that it does not contradict the Doctrine of the Sanctity of Human Life. In this response I will explore and defend against most of these claims, in doing so clarifying my original argument that the empirical and ethical differences between palliative opioid/sedative use and euthanasia may not be as significant as often believed, thereby advancing the case for euthanasia.

scholarly journals Patients’ priorities in a reminiscence and legacy intervention in palliative care

2019 ◽  
Vol 13 ◽  
pp. 263235241989262
Author(s):  
Michaela Hesse ◽  
Simon Forstmeier ◽  
Gülay Ates ◽  
Lukas Radbruch
Keyword(s):  
Palliative Care ◽  
Well Being ◽  
Life Review ◽  
University Hospital ◽  
Self Awareness ◽  
Growing Up ◽  
Philosophy Of Life ◽  
Dignity Therapy ◽  
And Coping ◽  
The University

Background: Reminiscence is used in a range of different interventions in palliative care, for example, Dignity Therapy or Life Review. However, literature has focused mainly on the methodology, and little has been published on patients’ priorities and primary concerns. Objective: This study looks at themes emerging in a reminiscence intervention with patients confronted with a life-limiting disease. Interviews were audiotaped and transcribed verbatim. Transcripts were analysed using thematic analysis. Setting/subjects: Seventeen patients who were receiving palliative care at the University Hospital Bonn participated in interviews reviewing parts or phases of their lives. Results: Patients expressed satisfaction and a sense of well-being with the intervention. Major themes emerging in the interviews were the factors involved in the development and expression of personality, such as character-forming influences, self-image, self-awareness, and philosophy of life. Talking about personality was entangled with influences from growing up, qualification/job, partner/spouse, children, resources, twists of fate/crossroads, and coping. Conclusion: The topics emerging from the interviews differed from the scope of guiding questions in common reminiscence methods like Life Review or Dignity Therapy. The underlying motivation of patients seemed to be the search for identity and continuity in one’s life.

Supportive and palliative care at the University Hospital Lausanne

1997 ◽  
Vol 5 (4) ◽  
pp. 265-268 ◽  
Author(s):  
C. Mazzocato ◽  
L. Barrelet ◽  
S. Blanchard ◽  
M. Tinghi ◽  
A. Vagnair ◽  
...  
Keyword(s):  
Palliative Care ◽  
University Hospital ◽  
The University

Analgesia, Virtue, and the Principle of Double Effect

2000 ◽  
Vol 16 (1_suppl) ◽  
pp. S24-S30 ◽  
Author(s):  
Laura A. Hawryluck ◽  
William R.C. Harvey
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Medical Literature ◽  
Double Effect ◽  
Care Providers ◽  
Dying Patients ◽  
Principle Of Double Effect ◽  
Important Challenge

The principle of double effect is widely used to permit the administration of narcotics and sedatives with the intent to palliate dying patients, even though the administration of these drugs may cause hastening of death. In recent medical literature, this principle's validity has been severely criticized, causing health care providers to fear providing good palliative care. Most of the criticisms levelled at the principle of double effect arise from misconceptions about its purpose and origins. This discussion will explore how virtue-based ethics can overcome the most important challenge to the principle of double effect's validity, that of its reliance on intention to determine whether the administration of analgesia is ethically acceptable.

Palliative sedation therapy for terminal movement disorders

2020 ◽  
pp. bmjspcare-2020-002577
Author(s):  
Daniel Kent Partain ◽  
April Zehm
Keyword(s):  
Medical Decision Making ◽  
Moral Distress ◽  
Lewy Bodies ◽  
Double Effect ◽  
Palliative Sedation ◽  
Medical Decision ◽  
Ethical Considerations ◽  
Unique Case ◽  
Palliative Sedation Therapy ◽  
Principle Of Double Effect

Palliative sedation therapy (PST) can be a challenging area of palliative medicine because of the complex ethical considerations involved. PST is a medical therapy used for refractory symptoms in terminally ill patients and is often considered ethically justified due to the principle of double effect. Even in cases where PST is clearly indicated such as refractory cancer pain, there is potential for moral distress among clinicians. Here, we present a unique case in which multiple therapeutic options were limited in a patient with overlapping diagnoses of catatonia, medication-induced extrapyramidal symptoms, and dementia with Lewy bodies. We review how existing frameworks can be applied to similar situations and offer practical strategies to support medical decision-making regarding PST and reduce the risk of moral distress among clinicians.

Weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation

2018 ◽  
Vol 45 (2) ◽  
pp. 125-130 ◽  
Author(s):  
Thomas David Riisfeldt
Keyword(s):  
Palliative Care ◽  
Survival Time ◽  
Empirical Evidence ◽  
Double Effect ◽  
Palliative Sedation ◽  
Ethical Principle ◽  
Doctrine Of Double Effect ◽  
Opioid Use ◽  
Care Services ◽  
Palliative Care Services

Opioid and sedative use are common ‘active’ practices in the provision of mainstream palliative care services, and are typically distinguished from euthanasia on the basis that they do not shorten survival time. Even supposing that they did, it is often argued that they are justified and distinguished from euthanasia via appeal to Aquinas’ Doctrine of Double Effect. In this essay, I will appraise the empirical evidence regarding opioid/sedative use and survival time, and argue for a position of agnosticism. I will then argue that the Doctrine of Double Effect is a useful ethical tool but is ultimately not a sound ethical principle, and even if it were, it is unclear whether palliative opioid/sedative use satisfy its four criteria. Although this essay does not establish any definitive proofs, it aims to provide reasons to doubt—and therefore weaken—the often-claimed ethical distinction between euthanasia and palliative opioid/sedative use.

Palliative Sedation, Compassionate Extubation, and the Principle of Double Effect: An Ethical Analysis

2021 ◽  
pp. 104990912199863
Author(s):  
Jordan Potter ◽  
Steven Shields ◽  
Renée Breen
Keyword(s):  
Medical Practice ◽  
Double Effect ◽  
Palliative Sedation ◽  
Ethical Analysis ◽  
Respiratory Drive ◽  
Clinical Scenario ◽  
Ethical Justification ◽  
Principle Of Double Effect ◽  
Life Sustaining Treatment

Palliative sedation is a well-recognized and commonly used medical practice at the end of life for patients who are experiencing refractory symptoms that cannot be controlled by other means of medical management. Given concerns about potentially hastening death by suppressing patients’ respiratory drive, traditionally this medical practice has been considered ethically justifiable via application of the ethical doctrine known as the Principle of Double Effect. And even though most recent evidence suggests that palliative sedation is a safe and effective practice that does not hasten death when the sedative medications are properly titrated, the Principle of Double Effect is still commonly utilized to justify the practice of palliative sedation and any risk—however small—it may entail of hastening the death of patients. One less common clinical scenario where the Principle of Double Effect may still be appropriate ethical justification for palliative sedation is when the practice of palliative sedation is pursued concurrently with the active withdrawal of life-sustaining treatment—particularly the practice of compassionate extubation. This case study then describes an unconventional case of palliative sedation with concurrent compassionate extubation where Principle of Double Effect reasoning was effectively employed to ethically justify continuing to palliatively sedate a patient during compassionate extubation.

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