Asian Bioethics Review

The acceptability of an action is determined by the intention behind it. This is particularly relevant within end-of-life care setting where acts of utilising treatments involving opioids and sedatives ostensibly to ameliorate suffering can result in the hastening of death of a terminally ill patient. It is in elucidating the dominant intentions behind the decision to utilise these drugs that determines its acceptability. Yet the process of determining the intentions of an individual is not easy. In the face of a rise in unsanctioned practices such as physician-assisted suicide and euthanasia, which continue to plague legitimate end-of-life practices, and mounting concerns as to the efficacy of prevailing methods of discernment of intentions, Palliative Medicine (PM) adopted a novel triadic approach to determining the acceptability of actions. The first was the employ of a Multi-Disciplinary Team (MDT) approach to ensure accountability within care determinations and to temper any ill-considered actions of any healthcare professional (HCP) within the team. The second was the employ of evidence-based medical practice and clear lines of accountability to all actions taken surrounding end-of-life care. Here, the combination of the MDT approach and having determinative processes shepherded by the law, corralled by regnant sociocultural and professional expectations, guided by professional standards and influenced and tampered by the MDT would mean that only a few intentions will be acted upon. This is deemed to improve the chances of delineating the primary intentions of a clinician. The third and final element to this approach was the employ of the Principle of Proportionality to determine if actions taken were both commensurate with the exigencies of the situation and in keeping with prevailing standards of legal practice, clinical guidelines and psychosocial expectations considered within the patient’s particular context.

This last element of this triadic approach has, however, faced increasing problems. The context-dependent nature of determinations of proportionality and the inherent subjectivity that accompanies such conditions raise questions as to the viability of this process. A return to the practice of elucidating intention has increasingly been called for, albeit this time in tandem with judgements as to the proportionality of an action within the prevailing evidence-based MDT approach.

This paper studies the viability of reintroduction of elucidations of intentions for the purposes of determining the acceptability of actions within the context of an evidence-based MDT approach. By doing so, it forwards the Model for the Elucidation of Intention (MEI) within the Multi-Disciplinary Team (MDT) as a means of confronting the inherent subjectivity within end-of-life care determinations.