Sedation practices, tragic dying and palliative care: An ethical inquiry.
Creators: name: Murphy, Kevin.
Publisher: name: Université d'Ottawa / University of Ottawa
Year: 2002
Subjects: subject: Theology.

description: With the increased ability of medical technology to manipulate or prolong the end of a patient's life, and with the increased dependency of patients on technology for survival and comfort, health care professionals who manipulate these "end of life" technologies seem to more directly manipulate the life and death of the patient. The end of life is the focus of the health care discipline of palliative care. It has been promoted as a holistic approach addressing the needs of dying patients which, if not addressed, give rise to requests for physician assisted suicide. Yet, concerns regarding the direct killing of patients also arise in palliative care through sedation practices. Discussion of this apparent contradiction is especially poignant given the value palliative care places on the dying process as a time of potential growth and self-actualization. Two traditional and foundational criteria within the principle of double effect (PDE) which are often cited as identifying significant ethical differences between killing and letting die are: (1) The psychological intention of the agent, (2) the direct/indirect action distinction. The problem is that the meaning and pertinence of these criteria have been argued as being both inadequate and adequate in demonstrating a moral difference between killing and letting die within healthcare debates. The question for palliative care clinicians is, "What is the ethically significant difference between killing and letting die in palliative care where death is not only foreseen through the treatment but, part of the complex act of doing good through the treatment, such as relieving pain and suffering?". A consistent goal of this inquiry has been to understand the one-sided nature of the principles, moralities and strategies implicit within palliative approaches to sedation practices. The moral reasoning implicit within the interpretation and application of PDE in palliative sedation literature was discovered to focus on the physical, causal or psychological intent of action and not integrate other elements signifying the moral intent or destiny of the action. Dialectics explored within the work of Paul Ricoeur offered insight into the complex operations within the process of interpretation and helped to frame and explore palliative sedation dilemmas as a complex problem of decision in situation. With novel palliative sedation dilemmas arising which betray convention, palliative care is engaged in a new moral frontier. The complexity and rawness of tragic suffering and dying, which accompanies the transition of identity and meaning of the patient, were discovered not as unexpected among palliative care professionals but interpreted as uncontrolled pathology and as the symbols of failure for palliative care. The humanization of dying, the ethical aim spawning the birth and genesis of palliative care, involved introducing a renewed vulnerability and mutuality within this clinical encounter. The challenge of re-establishing, continuing, and creating interpersonal meaning within the context of new and more dramatic forms of tragic suffering and fragmentation is the key challenge now facing the discipline of palliative care. Confronted by unique and tragic forms of dying, the resources of ethical deliberation, practical wisdom, vulnerability and mutuality between the self and the other, are approaches which palliative care professionals seek and yet feel ill prepared for by their own present health care formation.