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1.
BMC Med Ethics ; 22(1): 141, 2021 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666743

RESUMO

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.


Assuntos
Intenção , Assistência Terminal , Morte , Princípio do Duplo Efeito , Humanos , Cuidados Paliativos
2.
J Med Philos ; 46(5): 505-515, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34302349

RESUMO

The relevance of double effect for end-of-life decision-making has been challenged recently by a number of scholars. The principal reason is that opioids such as morphine do not usually hasten death when administered to relieve pain at the end of life; therefore, no secondary "double" effect is brought about. In my article, I argue against this view, showing how the doctrine of double effect is relevant to the administration of opioids at the end of life. I contend that the prevailing view suffers from a misunderstanding of the nature of double effect, which includes application to risking a grave harm.


Assuntos
Analgésicos Opioides , Dor , Analgésicos Opioides/efeitos adversos , Princípio do Duplo Efeito , Humanos , Dor/tratamento farmacológico
3.
J Law Med ; 28(2): 503-520, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33768755

RESUMO

Recent parliamentary inquiries into end-of-life choices identify the need to provide legal certainty for health practitioners working in end-of-life care. A concern identified is the lack of clarity surrounding the operation, status and application of the doctrine of double effect. This discussion clarifies these concerns. Although the doctrine is judicially recognised in several overseas jurisdictions, in Australia the doctrine of precedent means that it does not form part of the common law. In most jurisdictions, the fault element for murder includes recklessness, and application of the doctrine does not avoid criminal liability being established against orthodox criminal law principles. Although the prosecution of a medical practitioner who incidentally causes death in the proper course of medical treatment is a rare event, it remains a live issue. Legislative protection of medical practitioners, as has occurred in Queensland, South Australia and Western Australia, is the means to achieve the certainty sought.


Assuntos
Criminosos , Austrália , Princípio do Duplo Efeito , Humanos , Responsabilidade Legal , Queensland , Austrália Ocidental
4.
Am J Hosp Palliat Care ; 38(12): 1536-1540, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33657860

RESUMO

Palliative sedation is a well-recognized and commonly used medical practice at the end of life for patients who are experiencing refractory symptoms that cannot be controlled by other means of medical management. Given concerns about potentially hastening death by suppressing patients' respiratory drive, traditionally this medical practice has been considered ethically justifiable via application of the ethical doctrine known as the Principle of Double Effect. And even though most recent evidence suggests that palliative sedation is a safe and effective practice that does not hasten death when the sedative medications are properly titrated, the Principle of Double Effect is still commonly utilized to justify the practice of palliative sedation and any risk-however small-it may entail of hastening the death of patients. One less common clinical scenario where the Principle of Double Effect may still be appropriate ethical justification for palliative sedation is when the practice of palliative sedation is pursued concurrently with the active withdrawal of life-sustaining treatment-particularly the practice of compassionate extubation. This case study then describes an unconventional case of palliative sedation with concurrent compassionate extubation where Principle of Double Effect reasoning was effectively employed to ethically justify continuing to palliatively sedate a patient during compassionate extubation.


Assuntos
Extubação , Cuidados Paliativos , Princípio do Duplo Efeito , Análise Ética , Humanos , Hipnóticos e Sedativos
6.
Rev Med Suisse ; 17(722): 147-149, 2021 Jan 20.
Artigo em Francês | MEDLINE | ID: mdl-33470572

RESUMO

The death of a patient taking opioids can generate strong feelings of guilt. « Have I hastened my patient's death by my administration of opioids ? ¼ Doubts may arise in certain situations, despite the proven safety of appropriate opioid use in the management of dyspnea and pain in the palliative care setting. Fearing the harms of opioid administration, some medical practitioners may undertreat patients, forsaking them to suffering. Other doctors, desperate to relieve their excruciating suffering at all cost, may in fact have recourse to euthanizing acts. This article seeks to answer this ethical dilemma with an overview of the double effect principle.


Assuntos
Analgésicos Opioides , Cuidados Paliativos , Morte , Princípio do Duplo Efeito , Humanos , Dor/tratamento farmacológico
7.
Bioethics ; 34(9): 977-983, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32666526

RESUMO

Continuous deep sedation (CDS) has the effect of making the patient unconscious until death, and that it has this effect is clearly an undesirable aspect of CDS. However, some authors have recently maintained that many physicians do not intend this effect when practicing CDS. According to these authors, CDS is differentiated into two types; in what is called "gradual" CDS (or CDS as a result of proportionate palliative sedation), physicians start with low doses of sedatives and increase them only gradually, whereas in "rapid" CDS (or palliative sedation to unconsciousness), physicians rapidly administer a heavy dose that clearly induces unconsciousness from the beginning. The claim is that the physicians intend permanent unconsciousness only if they rapidly administer a heavy dose, but they do not intend it when the unconsciousness is the result of a gradual increase of sedatives. This paper attempts to refute these claims based on a close examination of the protocol of gradual CDS. If my argument is valid, the doctrine of double effect would not be useful in justifying most, if not all, cases of CDS.


Assuntos
Sedação Profunda , Médicos , Assistência Terminal , Princípio do Duplo Efeito , Humanos , Hipnóticos e Sedativos , Cuidados Paliativos , Inconsciência/induzido quimicamente
9.
J Med Ethics ; 46(1): 51-52, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31395696

RESUMO

In a recent article, 1 Riisfeldt attempts to show that the principle of double effect (PDE) is unsound as an ethical principle and problematic in its application to palliative opioid and sedative use in end-of-life care. Specifically, he claims that (1) routine, non-lethal opioid and sedative administration may be "intrinsically bad" by PDE's standards, (2) continuous deep palliative sedation (or "terminal sedation") should be treated as a bad effect akin to death for purposes of PDE, (3) PDE cannot coherently be applied in cases where death "indirectly" furthers an agent's intended end of pain relief via medically appropriate palliative care, and (4) application of PDE requires sacrificing common beliefs about the sanctity of human life. I respond by showing that Riisfeldt's understanding of PDE is seriously mistaken: he misattributes Kantian and Millian reasoning to the principle and conflates acts' intrinsic properties with their effects. Further, a corrected understanding of PDE can address Riisfeldt's case-specific objections.


Assuntos
Sedação Profunda , Eutanásia , Cuidados Paliativos na Terminalidade da Vida , Assistência Terminal , Princípio do Duplo Efeito , Humanos , Masculino , Cuidados Paliativos
10.
Cuad Bioet ; 30(100): 263-274, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31618589

RESUMO

Principlist Bioethics by Beauchamp and Childress has reached a prominent status in contemporary Bioethics. Nevertheless, it includes some important theoretical problems: some lacks when defining some concepts, a tendency to ethical relativism, etc. Among the ethical alternative approaches from which such problems can be solved, we think that the most appropiate is the Natural Law theory. It offers a reasoned reflection on the concept of good and on human basic goods and their relation with moral general principles. From such goods, this ethical theory supports the existence of actions that are always maleficent acts, that is, intrinsically and universally evil acts. The article applies the Natural Law theory to issues related to the protection of human life (abortion, euthanasia, self-defense and genetic manipulation)..


Assuntos
Bioética , Teoria Ética , Valor da Vida , Aborto Induzido/ética , Princípio do Duplo Efeito , Ética , Eutanásia/ética , Feminino , Engenharia Genética/ética , Homicídio/ética , Humanos , Masculino , Futilidade Médica/ética , Princípios Morais , Gravidez , Qualidade de Vida , Suicídio/ética , Suicídio Assistido/ética
11.
Rev. medica electron ; 40(4): 1232-1244, jul.-ago. 2018.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1103683

RESUMO

La responsabilidad médica en Chile contempla un espacio de discrecionalidad, en situaciones de peligro para la mujer durante el embarazo y en el tratamiento paliativo de pacientes terminales. En estos casos se presentan conceptos jurídicos indeterminados, en el ordenamiento jurídico chileno, que requieren de una propuesta interpretativa en consonancia con la protección del derecho a la vida, en actividades médicas que tengan por efecto colateral la muerte de personas inocentes (AU).


The chilean medical liability leaves a room of discretion in cases when a hazardous condition exists during the pregnancy or palliative care for those dying from a terminal disease. In such cases, the Chilean legal system presents undefined legal concepts. This concepts need to be in accordance with the promotion of the constitutional right to life, in medical cases where innocent people could die by side effect (AU).


Assuntos
Humanos , Masculino , Feminino , Responsabilidade Penal , Princípio do Duplo Efeito , Medicina Geral/legislação & jurisprudência , Pacientes/legislação & jurisprudência , Chile , Proteção , Morte , Mães/legislação & jurisprudência , Pessoas/legislação & jurisprudência
12.
Vitam Horm ; 107: 515-531, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29544642

RESUMO

Aberrant degradation of proteins is associated with many pathological states, including cancers. Mass spectrometric analysis of the tumor peptidome has the potential to provide biological insights on proteolytic processing in cancer. However, attempts to use the tumors peptidome information in cancer research have been fairly limited to date, largely due to the lack of effective approaches for robust peptidomics identification and quantification, and the prevalence of confounding factors and biases associated with sample handling and processing. To address this need, we have recently developed an effective and robust analytical platform as well as a novel informatics approach for comprehensive analyses of tissue peptidomes. The ability of this new peptidomics pipeline for high-throughput, comprehensive, and quantitative peptidomics analysis, as well as the suitability of clinical ovarian tumor samples with postexcision delay limited to less than 60min before freezing for peptidomics analysis, has been demonstrated. These initial analyses set a stage for further determination of molecular details and functional significance of the peptidomic activities in ovarian cancer.


Assuntos
Carcinoma/metabolismo , Proteínas de Neoplasias/metabolismo , Neoplasias Ovarianas/metabolismo , Ovário/metabolismo , Fragmentos de Peptídeos/metabolismo , Carcinoma/patologia , Carcinoma/cirurgia , Cromatografia Líquida de Alta Pressão , Quimotripsina/química , Quimotripsina/metabolismo , Análise por Conglomerados , Bases de Dados de Proteínas , Princípio do Duplo Efeito , Feminino , Humanos , Peso Molecular , Gradação de Tumores , Proteínas de Neoplasias/química , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Ovário/patologia , Ovário/cirurgia , Fragmentos de Peptídeos/química , Estabilidade Proteica , Proteólise , Proteômica/métodos , Análise de Regressão , Espectrometria de Massas em Tandem
13.
J Med Ethics ; 44(4): 266-269, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28899906

RESUMO

The doctrine of double effect (DDE) is a principle of crucial importance in law and medicine. In medicine, the principle is generally accepted to apply in cases where the treatment necessary to relieve pain and physical suffering runs the risk of hastening the patient's death. More controversially, it has also been used as a justification for withdrawal of treatment from living individuals and physician-assisted suicide. In this paper, I will critique the findings of the controversial Victorian Civil and Administrative Tribunal (VCAT) hearing Syme vs the Medical Board of Australia In that hearing, Dr Rodney Syme, a urologist and euthanasia advocate, was defending his practice of prescribing barbiturates to terminally ill patients. Syme claimed that he prescribed the drugs with the intention of relieving their existential suffering and not to assist in suicide; he argued that the DDE could be applied. Pace VCAT, I argue that this is an illegitimate application of DDE. I argue that a close scrutiny of Syme's actions reveals that, at the very least, he intended to give patients the option of suicide. He furthermore used what on a traditional definition of DDE would be considered a 'bad' means-the prescription of Nembutal-to achieve a 'good' end-the relief of suffering. The case demonstrates the crucial importance of analysing an agent's 'intention' and the 'effects' of their actions when applying DDE. Ethicists and, indeed, the judiciary need to attend to the ethical complexities of DDE when they assess the applicability of DDE to end of life care. If they fail to do this, the doctrine risks losing its legitimacy as an ethical principle.


Assuntos
Barbitúricos/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Eutanásia/ética , Suicídio Assistido/ética , Austrália , Princípio do Duplo Efeito , Prescrições de Medicamentos/história , Ética Médica , Eutanásia/história , História do Século XIX , Humanos , Intenção , Princípios Morais , Suicídio Assistido/história
15.
Br J Community Nurs ; 21(12): 633-635, 2016 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-27922774

RESUMO

The role of district nurses in the effective management of pain in palliative care has been strengthened by the Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations 2012 that allow district nurses who are independent or supplementary prescribers to prescribe and administer controlled drugs. However, prescribing controlled drugs brings increased responsibility and accountability for the safe management of these medicines. In this article Richard Griffith considers the principle of double effect that seeks to ensure that patients in intractable pain receive the analgesia they require to manage that pain while district nurses avoid liability and prosecution under the law of murder.


Assuntos
Analgésicos/uso terapêutico , Enfermagem em Saúde Comunitária/ética , Princípio do Duplo Efeito , Prescrições de Medicamentos/enfermagem , Papel do Profissional de Enfermagem , Dor Intratável/tratamento farmacológico , Dor Intratável/enfermagem , Atitude do Pessoal de Saúde , Humanos , Cuidados Paliativos , Autonomia Profissional , Reino Unido
16.
Acta bioeth ; 22(2): 179-185, nov. 2016.
Artigo em Espanhol | LILACS | ID: biblio-827604

RESUMO

El estudio muestra como la doctrina o principio del doble efecto (DDE) de una acción con efecto secundario negativo no puede aplicarse a todos los casos de aborto terapéutico (AT). Con el análisis de las causas e indicación de AT se demuestra que solo algunos de estos corresponden a DDE. Cuando no es el feto el que lleva a la madre a tener un embarazo de alto riesgo con amenaza de daño severo o muerte para ella, el caso puede adscribirse a la DDE; cuando es el feto directa o indirectamente el que causa a lleva a ese riesgo materno, el caso no se adscribe a la DDE. Si el feto es la causa de la muerte inminente de la madre, la remoción de la causa, que es la terapia adecuada, coincide con matarlo; entonces la acción buena (salvar a la madre tratándola causalmente) es la misma que la mala (matar al feto), situación que no puede asimilarse sea a la DDE o a la doctrina del mal menor. Más aún, decidir no interrumpir el embarazo produciría la muerte de la madre y el feto. El caso debería adscribirse al principio del único bien posible.


This study shows the inapplicability of the doctrine of double effect (DDE) to all the cases of therapeutic abortion (TA). The causes of the maternal risk define cases that cannot be included in the DDE. When it is not the embryo or fetus that produces the mother pathology the case can be assigned to the DDE. When the embryo or fetus produces directly or indirectly the process that threatens the mother’s life the case cannot be assigned to the DDE. If the fetus is the cause of the imminent mother’s death, the removal of the cause, that is the proper therapy, coincides with killing him or her; then the good action (to save therapeutically the mother) is the same to the bad action (to kill the fetus) and this situation cannot be assimilated either to the DDE or to the doctrine of the lesser evil. Deciding not to kill the fetus will produce the death of the mother and the fetus. So this situation should be ascribed to the principle of the unique possible well.


O estudo mostra como a doutrina ou princípio do duplo efeito (DDE) de uma ação com efeito secundário negativo não pode aplicar-se a todos os casos de aborto terapêutico (AT). Com a análise das causas e indicação de AT se demonstra que só alguns destes correspondem a DDE. Quando não é o feto que leva a mãe a ter uma gravidez de alto risco com ameaça de dano severo ou morte para ela, o caso pode circunscrever-se à DDE; quando é o feto direta ou indiretamente quem causa ou leva a esse risco materno, o caso não se circunscreve a DDE. Se o feto é a causa da morte iminente da mãe, a remoção da causa, que é a terapia adequada, coincide em matá-lo; então a ação boa (salvar a mãe tratando-a causalmente) é a mesma que a má (matar o feto), situação que não pode assimilar-se à DDE ou à doutrina do mal menor. Mais ainda, decidir não interromper a gravidez produziria a morte da mãe e do feto. O caso deveria circunscrever-se ao princípio do único bem possível.


Assuntos
Humanos , Aborto Terapêutico/ética , Princípio do Duplo Efeito , Ciência/ética
17.
J Med Ethics ; 42(6): 361-6, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27030484

RESUMO

While the Doctrine of Double Effect (DDE) remains controversial in ethical circles, it continues to be recognised in common law courts. In 2015, the High Court of New Zealand became the latest to acknowledge the existence of the DDE, in a case that challenged the prohibition on physician assisted dying. In so doing, the possibility was raised that the DDE could potentially be used in an untraditional way to provide a prima facie justification of "facilitated aid in dying" (FAID) in some cases.In this article, we develop and offer justification for this line of reasoning. If it can be shown that FAID sometimes satisfies the conditions for DDE, this, we suggest, may have significant implications for the aid in dying debate, not only in New Zealand, but more widely. Even if all of the elements of the DDE are not met in such cases, though, we suggest that one of those elements - the doctor's intent in providing FAID - may not always be such as to attract moral blame or criminal culpability.


Assuntos
Morte , Princípio do Duplo Efeito , Análise Ética , Ética Médica , Eutanásia/ética , Intenção , Dissidências e Disputas , Eutanásia/legislação & jurisprudência , Homicídio , Humanos , Princípios Morais , Nova Zelândia
19.
Bioethics ; 29(2): 74-81, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24320715

RESUMO

This paper examines the recent prominent view in medical ethics that withdrawing life-sustaining treatment (LST) is an act of killing. I trace this view to the rejection of the traditional claim that withdrawing LST is an omission rather than an act. Although that traditional claim is not as problematic as this recent prominent view suggests, my main claim is that even if we accepted that withdrawing LST should be classified as an act rather than as an omission, it could still be classified as letting die rather than killing. Even though omissions are contrasted with acts, letting die need not be, for one can let die by means of acts. The remainder of the paper is devoted to establishing this claim and addresses certain objections to it.


Assuntos
Eutanásia Passiva/ética , Homicídio , Intenção , Suspensão de Tratamento/ética , Princípio do Duplo Efeito , Ética Médica , Humanos , Direito a Morrer/ética
20.
J Clin Ethics ; 25(4): 261-72, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25517562

RESUMO

A first principle in ethics consultation is that reasoning is essential. A second principle is that the religious and cultural views of patients and their surrogates are usually respected. What can be done when these principles collide-when patients or surrogates have religious or cultural views and beliefs that clinicians find unreasonable or even offensive? Mediation may provide some approaches to assist us in providing the most ethically appropriate assistance.


Assuntos
Conflito de Interesses , Características Culturais , Tomada de Decisões/ética , Eticistas , Consultoria Ética , Futilidade Médica , Negociação , Resolução de Problemas/ética , Procurador , Religião e Medicina , Princípio do Duplo Efeito , Emoções , Eticistas/psicologia , Eticistas/normas , Consultoria Ética/ética , Consultoria Ética/normas , Humanos , Futilidade Médica/ética , Futilidade Médica/psicologia , Princípios Morais , Negociação/métodos , Negociação/psicologia , Manejo da Dor/ética , Pessoalidade , Papel Profissional , Qualidade de Vida , Diálise Renal/ética , Respiração Artificial/ética , Valores Sociais , Estresse Psicológico/prevenção & controle , Procedimentos Cirúrgicos Operatórios/ética , Estados Unidos
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