Palliative Options of Last Resort
Quill, Timothy E.
Brock, Dan W.
JAMA. 1997 Dec 17; 278(23): 2099-2104.
Palliative care is generally agreed to be the standard of care for the dying, but there remain some patients for whom intolerable suffering persists. In the face of ethical and legal controversy about the acceptability of physician-assisted suicide and voluntary active euthanasia, voluntarily stopping eating and drinking and terminal sedation have been proposed as ethically superior responses of last resort that do not require changes in professional standards or the law. The clinical and ethical differences and similarities between these 4 practices are critically compared in light of the doctrine of double effect, the active/passive distinction, patient voluntariness, proportionality between risks and benefits, and the physician's potential conflict of duties. Terminal sedation and voluntarily stopping eating and drinking would allow clinicians to remain responsive to a wide range of patient suffering, but they are ethically and clinically more complex and closer to physician-assisted suicide and voluntary active euthanasia than is ordinarily acknowledged. Safeguards are presented for any medical action that may hasten death, including determining that palliative care is ineffective, obtaining informed consent, ensuring diagnostic and prognostic clarity, obtaining an independent second opinion, and implementing reporting and monitoring processes. Explicit public policy about which of these practices are permissible would reassure the many patients who fear a bad death in their future and allow for a predictable response for the few whose suffering becomes intolerable in spite of optimal palliative care.
Active Euthanasia; Allowing to Die; Artificial Feeding; Assisted Suicide; Autonomy; Beneficence; Chronically Ill; Comparative Studies; Competence; Conscience; Consent; Death; Diagnosis; Double Effect; Drugs; Ethical Analysis; Euthanasia; Family Members; Food; Guidelines; Informed Consent; Intention; Law; Legal Aspects; Moral Policy; Pain; Palliative Care; Patients; Physician's Role; Physicians; Prognosis; Public Policy; Professional Standards; Risks and Benefits; Reporting; Sedatives; Standards; Suffering; Suicide; Terminal Care; Terminal Sedation; Treatment Refusal; Voluntary Euthanasia;
Showing items related by title, author, creator and subject.
Palliative Options of Last Resort: A Comparison of Voluntarily Stopping Eating and Drinking, Terminal Sedation, Physician-Assisted Suicide, and Voluntary Active Euthanasia Quill, Timothy E.; Lo, Bernard; Brock, Dan W. (2008)
Palliative Options of Last Resort: A Comparison of Voluntary Stopping Eating and Drinking, Terminal Sedation, Physician-Assisted Suicide, and Voluntary Active Euthanasia Quill, Timothy E.; Lo, Bernard; Brock, Dan W. (2004)