The Ambiguity of Clinical Intentions
Quill, Timothy E.
New England Journal of Medicine. 1993 Sep 30; 329(14): 1039-1040.
In summary, multilayered intentions are present in most, if not all, end-of-life decisions. To understand physicians' reluctance to stop life-sustaining treatment once it is started, or to prescribe adequate amounts of narcotics to patients who are dying and in severe pain, we would do well to look beneath the idealized, sanitized intentions espoused by many medical ethicists to the actual experience of doctors and patients. If we do not clarify the ethical and legal status of such actions as prescribing barbiturates to terminally ill patients, with their inherent complexities and contradictions, then most physicians will remain too fearful to help patients with these delicate deliberations. If we do not acknowledge the inescapable multiplicity of intentions in most double-effect situations, physicians may retreat from aggressive palliative treatment out of fear of crossing the allegedly bright line between allowing patients to die and causing their death. Our current ethical thinking and legal prohibitions reinforce self-deception, secrecy, isolation, and abandonment at a time when the exact opposite is needed. Perhaps a key to humanizing medical ethics and the law, as well as clinical medicine, lies in being more forthright and explicit about our intentions and responsibilities in working with dying patients.
Assisted Suicide; Autonomy; Compassion; Death; Deception; Decision Making; Double Effect; Drugs; Doctors; Dying Patients; Ethicists; Ethics; Intention; Killing; Law; Legal Aspects; Life; Medical Ethics; Medicine; Motivation; Pain; Palliative Care; Patients; Physicians; Right to Die; Responsibilities; Suffering; Suicide; Terminal Care; Terminally Ill;
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Quill, Timothy E. (1993-09-30)
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