The role of the principle of double effect in ethics education at US medical schools and its potential impact on pain management at the end of life
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
Learn more about PhilPapers
Journal of Medical Ethics 38 (3):174-178 (2012)
Background Because opioids can suppress respiratory drive, the principle of double effect (PDE) has been used to justify their use for terminally ill patients. Recent studies, however, suggest that the risk of respiratory depression in typical end-of-life (EOL) situations may be overstated and that heightened concern for this rare occurrence can lead to inadequate treatment of pain. The purpose of this study is to examine the role of the PDE in medical school ethics education, with specific reference to its potential impact on pain management at EOL. Method After obtaining institutional review board approval, an electronic survey was sent to ethics educators at every allopathic medical school in the USA. Results One-third of ethics educators felt that opioids were ‘likely’ to cause significant respiratory depression that could hasten death. Educators' opinions of opioid effects did not influence their view of the relevance of the PDE, with approximately 70% deeming it relevant to EOL care. Only 15% of ethics educators believed that associating the PDE with opioid use might discourage clinicians from optimally treating pain, out of concern for respiratory depression. Conclusion This study demonstrates that a significant minority of ethics educators believe, contrary to current evidence, that opioids are ‘likely’ to cause significant respiratory depression that could hasten death in terminally ill patients. Yet, many of those who do not feel this is likely still rely on the PDE to justify this possibility, potentially (and unknowingly) contributing to clinical misperceptions and underutilisation of opioids at EOL
|Keywords||No keywords specified (fix it)|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
No references found.
Citations of this work BETA
No citations found.
Similar books and articles
T. A. Cavanaugh (2006). Double-Effect Reasoning: Doing Good and Avoiding Evil. Oxford University Press.
B. J. Zikmund-Fisher, H. P. Lacey & A. Fagerlin (2008). The Potential Impact of Decision Role and Patient Age on End-of-Life Treatment Decision Making. Journal of Medical Ethics 34 (5):327-331.
Peter Allmark, Mark Cobb, B. Jane Liddle & Angela Mary Tod (2010). Is the Doctrine of Double Effect Irrelevant in End-of-Life Decision Making? Nursing Philosophy 11 (3):170-177.
David F. Kelly (2004). Contemporary Catholic Health Care Ethics. Georgetown University Press.
D. W. Musick (1999). Teaching Medical Ethics: A Review of the Literature From North American Medical Schools with Emphasis on Education. [REVIEW] Medicine, Health Care and Philosophy 2 (3):239-254.
N. Lynoe, R. Lofmark & H. O. Thulesius (2008). Teaching Medical Ethics: What is the Impact of Role Models? Some Experiences From Swedish Medical Schools. Journal of Medical Ethics 34 (4):315-316.
Anna Lindblad, Niels Lynöe & Niklas Juth (2014). End‐of‐Life Decisions and the Reinvented Rule of Double Effect: A Critical Analysis. Bioethics 28 (7):368-377.
Esther Roca (2008). Introducing Practical Wisdom in Business Schools. Journal of Business Ethics 82 (3):607 - 620.
Lawrence Masek (2011). The Contralife Argument and the Principle of Double Effect. National Catholic Bioethics Quarterly 11 (1):83-97.
Joseph Boyle (1991). Who is Entitled to Double Effect? Journal of Medicine and Philosophy 16 (5):475-494.
Joseph Mangan (1949). An Historical Analysis of the Principle of Double Effect. Theological Studies 10:41-61.
Alain Lapointe & Corinne Gendron (2006). Developing Critical Thinking About the Role of Business as a Private Social Institution. Proceedings of the International Association for Business and Society 17:307-312.
Lawrence Masek (2010). Intentions, Motives and the Doctrine of Double Effect. Philosophical Quarterly 60 (240):567-585.
David E. Weissman & Sandra Matson (1999). Pain Assessment and Management in the Long-Term Care Setting. Theoretical Medicine and Bioethics 20 (1):31-43.
Added to index2011-09-25
Total downloads6 ( #214,088 of 1,101,945 )
Recent downloads (6 months)2 ( #192,006 of 1,101,945 )
How can I increase my downloads?