Therapeutic ratio and defined phases: proposal of ethical framework for palliative care.

Ashby, Michael; Stoffell, Brian

doi:10.1136/bmj.302.6788.1322

Cited by 32 publications

(17 citation statements)

References 14 publications

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“…The consensus in the hospice movement seems to be that rehydration and intravenous fluids are inappropriate in terminal care (2,18,19). Dehydration is even considered to be beneficial in patients with incontinence (18)!…”

Section: The Importance Of Comfortmentioning

confidence: 99%

On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far?

Craig¹

1994

J Med Ethics

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This paper explores ethical issues relating to the management of patients who are terminally ill and unable to maintain their own nutrition and hydration. A policy of sedation without hydration or nutrition is used in palliative medicine under certain circumstances. The author argues that this policy is dangerous, medically, ethically and legally, and can be disturbing for relatives. The role of the family in management is discussed. This issue requires wide debate by the public and the profession.

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Section: The Importance Of Comfortmentioning

confidence: 99%

On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far?

Craig¹

1994

J Med Ethics

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“…We will argue that the ethical reasoning which we have developed to describe our Key words Nutrition; hydration; death; dying; palliative care. practice of palliative care can accommodate Dr Craig's concerns (2). The sensitivities and consultative process of negotiation which she articulates are well heard, and we believe are already embodied in contemporary palliative care practice.…”

Section: Introductionmentioning

confidence: 91%

Artificial hydration and alimentation at the end of life: a reply to Craig.

Ashby

Stoffell

1995

J Med Ethics

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Dr Gillian Craig (1) has argued that palliative medicine services have tended to adopt a policy of sedation without hydration, which under certain circumstances may be medically inappropriate, causative ofdeath and distressing to family andfriends. We welcome this opportunity to defend, with an important modification, the approach we proposed without substantive background argument in our original article (2). We maintain that slowing and eventual cessation oforal intake is a normal part of a natural dying process, that artificial hydration and alimentation (AHA) are notjustified unless thirst or hunger are present and cannot be relieved by other means, butfood andfluids for (natural) oral consumption should never be 'withdrawn'. The intention of this practice is not to alter the timing of an inevitable death, and sedation is not used, as has been alleged, to mask the effects of dehydration or starvation. The artificial provision ofhydration and alimentation is now widely accepted as medical treatment. We believe that arguments that it is not have led to confusion as to whether or not non-provision or withdrawal ofAHA constitutes a cause of death in law. Arguments that it is such a cause appear to be tenuously based on an extraordinary/ordinary categorisation of treatments by Kelly (3) which has subsequently been interpreted as prescriptive in a way quite inconsistent with the Catholic moral theological tradition from which the distinction is derived. The focus of ethical discourse on decisions at the end of life should be shifted to an analysis of care, needs, proportionality of medical interventions, and processes of communication.

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“…. ," 57 Bleich noted that the connection of respiratory depression with pain control is based more on myth than on medical fact, and argued that the PDE should not be applied to the risk of hastening death from pain medication. As he put it, the "assumption of prudent risk is synonymous with life.…”

Section: Undertreatment Of Pain Due To Belief In the Double Effectmentioning

confidence: 98%

The Double Effect of Pain Medication: Separating Myth from Reality

Fohr¹

1998

Journal of Palliative Medicine

113

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The principle of double effect is used to justify the administration of medication to relieve pain even though it may lead to the unintended, although foreseen, consequence of hastening death by causing respiratory depression. Although a review of the medical literature reveals that the risk of respiratory depression from opioid analgesic is more myth than fact and that there is little evidence that the use of medication to control pain hastens death, the belief in the double effect of pain medication remains widespread. Applying the principle of double effect to end-of-life issues perpetuates this myth and results in the undertreatment of physical suffering at the end of life. The concept of double effect of opioids also has been used in support of legalization of physician-assisted suicide and euthanasia.

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Therapeutic ratio and defined phases: proposal of ethical framework for palliative care.

Cited by 32 publications

References 14 publications

On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far?

On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far?

Artificial hydration and alimentation at the end of life: a reply to Craig.

The Double Effect of Pain Medication: Separating Myth from Reality

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