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Shenouda J, Blaber M, George R, Haslam J. The debate rages on: physician-assisted suicide in an ethical light. Br J Anaesth 2024; 132:1179-1183. [PMID: 38290905 DOI: 10.1016/j.bja.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
The British Medical Association and some Royal Colleges have recently changed their stance on physician-assisted suicide from 'opposed' to forms of 'neutral'. The Royal College of Anaesthetists will poll members soon on whether to follow suit. Elsewhere neutrality amongst professional bodies has preceded legalisation of physician-assisted suicide. We examine the arguments relevant to the anaesthesia community and its potential impact in the UK.
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Affiliation(s)
- John Shenouda
- Anaesthetics, Perioperative Medicine and Pain Department, The Royal Marsden Hospital, London, UK.
| | - Michael Blaber
- Connected Palliative Care, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Robert George
- Department of Palliative Care and Policy, Cicely Saunders' Institute, King's College London, London, UK
| | - James Haslam
- Radnor Intensive Care Unit, Salisbury NHS Foundation Trust, Salisbury, UK
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Gilbertson L, Savulescu J, Oakley J, Wilkinson D. Expanded terminal sedation in end-of-life care. JOURNAL OF MEDICAL ETHICS 2023; 49:252-260. [PMID: 36543531 PMCID: PMC10086483 DOI: 10.1136/jme-2022-108511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/04/2022] [Indexed: 06/17/2023]
Abstract
Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term 'Expanded TS' (ETS) can be used to describe the use of sedation at the end of life outside one or more of these limits.In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We argue that ETS is morally permissible: (1) in cases of non-refractory suffering where earlier treatments are likely to fail, (2) where gradual sedation is likely to be ineffective or where unconsciousness is a clinically desirable outcome, (3) where the patient meets all criteria for assisted dying or (4) where the patient has greater than 2 weeks to live, is suffering intolerably, and sedation is considered to be the next best treatment option for their suffering.While remaining two distinct practices, there is scope for some convergence between the criteria for assisted dying and the criteria for ETS. Dying patients who are currently ineligible for TS, or even assisted dying, should not be left to suffer. ETS provides one means to bridge this gap.
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Affiliation(s)
- Laura Gilbertson
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Justin Oakley
- Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Care, John Radcliffe Hospital, Oxford, UK
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Affiliation(s)
- M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
| | - T Selak
- Department of Anaesthesia, Wollongong Hospital, Wollongong, NSW, Australia
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Takla A, Savulescu J, Wilkinson DJC, Pandit JJ. Ethical and practical questions in satisfying the human right to unconsciousness at the end of life: a reply. Anaesthesia 2021; 77:233-234. [PMID: 34714543 DOI: 10.1111/anae.15611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- A Takla
- University of Oxford, Oxford, UK
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Faris H, Dewar B, Dyason C, Dick DG, Matthewson A, Lamb S, Shamy MCF. Goods, causes and intentions: problems with applying the doctrine of double effect to palliative sedation. BMC Med Ethics 2021; 22:141. [PMID: 34666743 PMCID: PMC8527703 DOI: 10.1186/s12910-021-00709-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Palliative sedation and analgesia are employed in patients with refractory and intractable symptoms at the end of life to reduce their suffering by lowering their level of consciousness. The doctrine of double effect, a philosophical principle that justifies doing a "good action" with a potentially "bad effect," is frequently employed to provide an ethical justification for this practice. MAIN TEXT We argue that palliative sedation and analgesia do not fulfill the conditions required to apply the doctrine of double effect, and therefore its use in this domain is inappropriate. Furthermore, we argue that the frequent application of the doctrine of double effect to palliative sedation and analgesia reflects physicians' discomfort with the complex moral, intentional, and causal aspects of end-of-life care. CONCLUSIONS We are concerned that this misapplication of the doctrine of double effect can consequently impair physicians' ethical reasoning and relationships with patients at the end of life.
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Affiliation(s)
- Hannah Faris
- Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Brian Dewar
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Claire Dyason
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - David G Dick
- Department of Philosophy, University of Calgary, Calgary, Canada.,Canadian Centre for Advanced Leadership, Haskayne School of Business, University of Calgary, Calgary, Canada
| | | | - Susan Lamb
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada
| | - Michel C F Shamy
- Department of Medicine, University of Ottawa, Ottawa, Canada.,The Ottawa Hospital, Ottawa, Canada
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Iliff HA, El-Boghdadly K, Finlay I. General anaesthesia and euthanasia: difficulties defining the difference in end-of-life care. Anaesthesia 2021; 77:232-233. [PMID: 34658012 DOI: 10.1111/anae.15605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/17/2022]
Affiliation(s)
- H A Iliff
- Cwm Taf Morgannwg University Health Board, Merthyr, UK
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Morfey D. General anaesthesia in end-of-life care: extending the indications for anaesthesia beyond surgery. Anaesthesia 2021; 77:231. [PMID: 34636407 DOI: 10.1111/anae.15603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 01/23/2023]
Affiliation(s)
- D Morfey
- University Hospitals of Leicester NHS Trust, Leicester, UK
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Takla A, Savulescu J, Wilkinson DJC, Pandit JJ. General anaesthesia does not inevitably result in apnoea or require ventilatory support. Anaesthesia 2021; 76:1543. [PMID: 34251682 DOI: 10.1111/anae.15539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- A Takla
- University of Oxford, Oxford, UK
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Yip YY, Cheung JCH, Cheung EHL. Sedation and general anaesthesia in end-of-life care: the boundary has to be defined. Anaesthesia 2021; 76:1542. [PMID: 34044468 DOI: 10.1111/anae.15515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Y Y Yip
- Prince of Wales Hospital, Hong Kong, China
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