Goods, causes and intentions: problems with applying the doctrine of double effect to palliative sedation.

BACKGROUND: Palliative sedation and analgesia are employed in patients with refractory and intractable symptoms at the end of life to reduce their suffering by lowering their level of consciousness. The doctrine of double effect, a philosophical principle that justifies doing a "good action" with a potentially "bad effect," is frequently employed to provide an ethical justification for this practice. MAIN TEXT: We argue that palliative sedation and analgesia do not fulfill the conditions required to apply the doctrine of double effect, and therefore its use in this domain is inappropriate. Furthermore, we argue that the frequent application of the doctrine of double effect to palliative sedation and analgesia reflects physicians' discomfort with the complex moral, intentional, and causal aspects of end-of-life care. CONCLUSIONS: We are concerned that this misapplication of the doctrine of double effect can consequently impair physicians' ethical reasoning and relationships with patients at the end of life.

Heavy metal (Pb, Zn, Cd, Fe, and Cu) contents of plant foliage near the Anvil Range lead/zinc mine, Faro, Yukon Territory.

Mining and processing of lead (Pb)/zinc (Zn) ore at the Anvil Range mine occurred near the town of Faro in the Yukon Territory, Canada, for approximately 30 years, beginning in 1968. A study was undertaken to examine whether the mining activities had left a detectable "footprint" on the environment in the way of heavy metal phytoaccumulation. Foliage of three native plant species was sampled: bog blueberry (Vaccinium uliginosum), Labrador tea (Ledum groenlandicum), and willow (Salix sp.), at approximately 0.25, 2.5, 12, 30, and 200 (control) km distant from the mill (ore-processing facility at the mine). Foliage samples were oven-dried, wet- or dry-ashed, and analyzed for metal content using ICP-AES. In addition to Pb and Zn, the primary ore constituents, copper (Cu), iron (Fe), and cadmium (Cd), were also assayed. As expected, foliar Pb and Zn concentrations were elevated in plants at the sites closest to the mill, i.e., 0.25 and 2.5 km from the mine facility. Copper and Fe, both essential nutrients for plants, were also elevated in foliage at the sites closest to the mill, but not to a level that would be of concern. Foliar Cd levels were highest in Salix relative to the other species but were not affected by proximity to the mill. Results suggest that Ledum may be the best indicator of high environmental concentrations of Pb, while Salix may be the best indicator of elevated Zn and Cd.