Palliative Sedation at the End of Life Uses and Abuses

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Cassel E.J. The Nature of Suffering and the Goals of Medicine, 2nd ed. (New York: Oxford University Press, 2004).

Jansen L.A. , and Sulmasy D.P. “Proportionality, Terminal Suffering and the Restorative Goals of Medicine,” Theoretical Medicine and Bioethics 23 (2002): 321–337.

Jansen L.A. , and Sulmasy D.P. “Proportionality, Terminal Suffering and the Restorative Goals of Medicine,” Theoretical Medicine and Bioethics 23 (2002): 325.

Jansen L.A. , and Sulmasy D.P. “Proportionality, Terminal Suffering and the Restorative Goals of Medicine,” Theoretical Medicine and Bioethics 23 (2002): 327.

Bentz Charles conversation with author, Portland, Oregon, September 2008.

See for example, Claessens P. “Palliative Sedation: A Review of the Research Literature,” Journal of Pain and Symptom Management 36 (2008): 310–333.

Hospice and Palliative Nurses Association, “Palliative Sedation,” position statement, emphasis added, http://www.hpna.org/pdf/PositionStatement_PalliativeSedation.pdf.

Quill T.E. , and Byock I.R. “Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids,” Annals of Internal Medicine 132 (2000): 408–414.

Rousseau P. “Palliative Sedation in the Management of Refractory Symptoms,” The Journal of Supportive Oncology 2.2 (2004): 181–186.

http://ethics.iit.edu/codes/coe/amer.medical.assoc.prin.med.ethics.html.

For a commentary on the principle of double effect as it should be properly used in medicine, see D.P. Sulmasy and E.D. Pellegrino, “The Rule of Double Effect,” Archives of Internal Medicine 159 (1999): 545–550.

Quill T.E. , Lo B. , and Brock D.W. “Palliative Care Options of Last Resort,” Journal of the American Medical Association 278.33 (1997): 2099–2104.

Jansen , and Sulmasy “Proportionality, Terminal Suffering,” 329–330.

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http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html.

Quill , and Byock , “Responding to Intractable Terminal Suffering,” 408–409, emphasis added.

Quill , and Byock , “Responding to Intractable Terminal Suffering,” 410, emphasis added.

Quill , and Byock , “Responding to Intractable Terminal Suffering,” 411, emphasis added.

OHSU Health Care System, Administrative Policy Manual, ch. 7, “Personnel & Human Resources; Conscientious Objection,” Adm 07.05. I last reviewed this policy on August 30, 2006.

Finucane Thomas “How Gravely Ill Becomes Dying: A Key to End-of-Life Care,” Journal of the American Medical Association 282 (1999): 1670–1672, quotes published data from a large multi-center prospective observational study: SUPPORT Principal Investigators, “A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT),” Journal of the American Medical Association 274 (1995): 1591-1598. This study found, using hospice criteria for a “life expectancy of 6 months or less,” that 70 percent of patients identified as terminal (in a subgroup of patients with CHF, COPD, and end-stage liver disease) were still alive at 6 months. “As the authors eloquently state, many of these chronically ill patients ‘never experience a time during which they are clearly dying of their disease.’” Physicians know how very difficult it is to predict accurately when a patient is going to die, except in the very last stages of their illness. This makes legislative efforts like AB 2747 with provisions of “up to one year to live,” as originally drafted, extremely dangerous.

Rousseau “Palliative Sedation,” 183.

Rousseau “Palliative Sedation,” 182.

http://www.pccef.org.

http://www.take-the-pledge.com/take_the_pledge.htm?step=3&country=US&utid=1.

http://www.supportivecarecoalition.org.

http://www.marthamaryministries.org.