Special ArticleThe Ethical Validity and Clinical Experience of Palliative Sedation
Section snippets
ETHICAL VALIDITY
The ethical basis of PS derives from the principle of double effect, a concept developed by Roman Catholic theologians in the Middle Ages9, 10 and applied to situations in which it is impossible for a person to avoid all harmful actions.10, 11 The ethical principle of autonomy and the precept of informed consent are also fundamentally involved in the use of PS and directly interface with the intent of double effect.
The traditional formulations of the doctrine of double effect emphasize 4 basic
CLINICAL EXPERIENCE
The literature on palliative medicine has modestly addressed the use of PS, with a small number of retrospective and prospective studies,5, 15, 16, 17, 18, 19, 20, 21, 22 an article recounting 3 case reports,23 and another article detailing the results of an international mail survey24 (Table 1).
Ventafridda et al15 studied symptom prevalence during the last week of life in 120 terminally ill patients with metastatic cancer assisted by a home care team of the National Cancer Institute of Milan,
DISCUSSION
The process of dying is a ubiquitous milestone that allows patients and family members a time of reconciliation, growth, and spiritual enrichment as life enters its final chapter.26, 27 Lamentably, it can also be a time of consider able suffering, abolishing hope of a serene death, precipitating physical and emotional anguish, and fomenting requests for physician-assisted death. When palliative interventions have been exhausted and symptoms remain refractory, many palliative care clinicians
CONCLUSION
To care for a dying person is an honor and privilege afforded few in our society. As physicians, our main goal is to reduce suffering, including pain, physical symptoms, and emotional, psychosocial, and spiritual distress. In refractory and intractable cases, PS offers a compassionate and humane alternative to conscious and continual suffering, both for the patient and the patient's family.26 Without a doubt, further studies are necessary, particularly in cognitive impairment, but PS is a
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