Managing intentions: The end-of-life administration of analgesics and sedatives, and the possibility of slow euthanasia
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Bioethics 22 (7):388-396 (2008)
There has been much debate regarding the 'double-effect' of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing 'slow euthanasia.' On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten death. In this paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary 'slow euthanasia'). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a 'grey' area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that 'slow euthanasia' may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of 'time' for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed.
|Keywords||double effect hypnotics and sedatives terminal care euthanasia qualitative research end‐of‐life intention|
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References found in this work BETA
J. J. M. van Delden (2007). Terminal Sedation: Source of a Restless Ethical Debate. Journal of Medical Ethics 33 (4):187.
Anna P. Folker, Nils Holtug, Annette B. Jensen, Klemens Kappel & Jesper K. Nielsen Andmichael Norup (1996). Experiences and Attitudes Towards End-of-Life Decisions Amongst Danish Physicians. Bioethics 10 (3):233–249.
Citations of this work BETA
Jan L. Bernheim, Wim Distelmans, Arsène Mullie & Michael A. Ashby (2014). Questions and Answers on the Belgian Model of Integral End-of-Life Care: Experiment? Prototype? Journal of Bioethical Inquiry 11 (4):507-529.
L. A. Jansen (2010). Disambiguating Clinical Intentions: The Ethics of Palliative Sedation. Journal of Medicine and Philosophy 35 (1):19-31.
Samuel H. LiPuma (2011). The Lacking of Moral Equivalency for Continuous Sedation and PAS. American Journal of Bioethics 11 (6):48 - 49.
Charles Douglas (2009). End-of-Life Decisions and Moral Psychology: Killing, Letting Die, Intention and Foresight. [REVIEW] Journal of Bioethical Inquiry 6 (3):337-347.
Jeffrey Kirby (2010). Accessing the Ethics of Complex Health Care Practices: Would a “Domains of Ethics Analysis” Approach Help? [REVIEW] HEC Forum 22 (2):133-143.
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