End‐of‐Life Decisions and the Reinvented Rule of Double Effect: A Critical Analysis

Lindblad, Anna; Lynøe, Niels; Juth, Niklas

doi:10.1111/bioe.12001

Cited by 11 publications

(5 citation statements)

References 70 publications

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“…As discussed above, the distinction lies in the intention, which is to provide symptom control around the end of life and not hasten it. This principle, known as the `doctrine of double effect´, is aligned with ethics and law across many jurisdictions and religions, serving as a conduit for effective treatment [30].…”

Section: Do Analgesia and Sedation Hasten Death?mentioning

confidence: 99%

End‐of‐life care in the intensive care unit

et al. 2023

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The transition from active, invasive interventions to comfort care for critical care patients is often fraught with misunderstandings, conflict and moral distress. The most common issues that arise are ethical dilemmas around the equivalence of withholding and withdrawing life-sustaining treatment; the doctrine of double effect; the balance between paternalism and shared decision-making; legal challenges around best-interest decisions for patients that lack capacity; conflict resolution; and practical issues during the limitation of treatment. The aim of this article is to address commonly posed questions on these aspects of end-of-life care in the intensive care unit, using best available evidence, and provide practical guidance to critical care clinicians in the UK. With the help of case vignettes, we clarify the disassociation of withdrawing and/or withholding treatment from euthanasia; offer practical suggestions for the use of sedation and analgesia around the end of life, dissipating concerns about hastening death; and advocate for the inclusion of family in decision-making, when the patient does not have capacity. We propose a step-escalation approach in cases of family conflict and advocate for incorporation of communication skills during medical and nursing training.

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Section: Do Analgesia and Sedation Hasten Death?mentioning

confidence: 99%

End‐of‐life care in the intensive care unit

et al. 2023

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“…Este principio adquiere una mayor relevancia ética en la sedación aplicada a pacientes en situación avanzada de enfermedad, donde no se tiene constancia clara o definida de los últimos días o semanas de vida. Así, la doctrina del doble efecto podría apelarse en estos casos, como una justificación ética, atendiendo a la intención (alivio del sufrimiento, nunca intencionalidad de provocar la muerte) y la proporcionalidad (reducción del nivel de conciencia suficiente para aliviar, tratar el síntoma o síntomas que inducen sufrimiento) de las actuaciones de manera que las complicaciones no serían ni intencionadas ni deseadas, sino asumidas, por lo que no deben generar ningún tipo de duda entre paciente y familiares ya que deben conocer que la sedación se aplica porque el beneficio supera al riesgo (Lindblad, 2014). En este sentido el principio de doble efecto no debe comprenderse como una "autorización lícita" para causar un efecto negativo, sino que cobra su significado como un efecto colateral involuntario de una acción necesaria para alcanzar un bien (Miranda, 2008).…”

Section: Relevancia Del Principio De Doble Efectounclassified

Sedación paliativa en el final de la vida

Garcia¹

2022

RIB

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La sedación paliativa es una práctica clínica ampliamente asumida y aplicada en situaciones que anticipan el final de la vida. No obstante, a pesar de sus beneficios cuando los síntomas refractarios no tienen otra alternativa, en algunas ocasiones la sedación puede ser fuente de numerosos dilemas bioéticos relacionados con el principio de doble efecto que actúa como una de las herramientas base, en el ámbito de la bioética, sobre las que puede sustentarse la licitud de la sedación en el final de la vida.

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“…We briefly discussed the DDE in the original article1 and have discussed it at length elsewhere 7. We will not repeat that discussion here, but only make a few brief remarks.…”

Section: Moral Difference In Intentions?mentioning

confidence: 99%

Moral differences in deep continuous palliative sedation and euthanasia

Juth

Lindblad

Lynøe

et al. 2013

BMJ Support Palliat Care

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In palliative care there is much debate about which end of life treatment strategies are legitimate and which are not. Some writers argue that there is an important moral dividing-line between palliative sedation and euthanasia, making the first acceptable and the latter not. We have questioned this. In a recent article, Lars Johan Materstvedt has argued that we are wrong on two accounts: first, that we fail to account properly for the moral difference between continuous deep palliative sedation at the end of life and euthanasia, and, second, that we fail to account properly for the difference between permanent loss of consciousness and death. Regarding the first objection, we argue that Materstvedt misses the point: we agree that there is a difference in terms of intentions between continuous deep palliative sedation and euthanasia, but we question whether this conceptual difference makes up for a moral difference. Materstvedt fails to show that it does. Regarding the second objection, we argue that if nothing else is at stake than the value of the patient's life, permanent unconsciousness and death are morally indifferent.

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End‐of‐Life Decisions and the Reinvented Rule of Double Effect: A Critical Analysis

Cited by 11 publications

References 70 publications

End‐of‐life care in the intensive care unit

End‐of‐life care in the intensive care unit

Sedación paliativa en el final de la vida

Moral differences in deep continuous palliative sedation and euthanasia

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