Lynn A. Jansen, RN, PhD; Daniel P. Sulmasy, OFM, MD, PhD
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Jansen L., Sulmasy D.; Careful Conversation about Care at the End of Life. Ann Intern Med. 2002;137:1010. doi: 10.7326/0003-4819-137-12-200212170-00028
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Published: Ann Intern Med. 2002;137(12):1010.
We do not believe that the rule of double effect can be reduced to the distinction between physical and existential suffering. This distinction is important in applying the proportionality clause in the rule of double effect, but the rule should not be identified with this clause. Nor do we deny that this rule is controversial or that it is sometimes difficult to apply. But like any other moral rule, neither the fact that it can be misapplied nor the fact that it has its origins in religious thought establishes it as invalid. Properly understood, the rule of double effect holds that it is wrong for a clinician to intend to make a patient permanently unconscious as a means of treating his suffering. It does not forbid risking permanent unconsciousness as an unintended side effect of treating suffering occasioned by severe symptoms, such as dyspnea. Nor does it forbid respite sedation, which is intended to reduce consciousness temporarily. A distinction between primary and secondary sedation is an interesting suggestion and deserves further discussion. However, the rule of double effect could still be used to justify benzodiazepine coma for refractory delirium, even if the drugs do not treat the underlying delirium, because the clinician is aiming to eliminate hallucinations and agitation.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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