Careful Conversation about Care at the End of Life
Authors: Timothy E. Quill
Journal: Annals of Internal Medicine (2002)

Letters17 December 2002Careful Conversation about Care at the End of LifeTimothy E. Quill, MDTimothy E. Quill, MDUniversity of Rochester School of Medicine; Rochester, NY 14642Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-12-200212170-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I agree with Jansen and Sulmasy (1) that terminal sedation and voluntarily stopping eating and drinking are more morally complex than is usually acknowledged (2-4). In their paper, only case 2 was fully consistent with the rule of double effect because sedation was an unintended but foreseen consequence. But might not the purposeful sedation in case 1 have been intended to relieve suffering and the shortening of life only foreseen? (Furthermore, to suggest that this patient, who had severe muscle weakness, required intermittent respiratory support, and feared impending loss of dignity had disproportionately mild existential suffering seems ...Reference2. Jansen LA, Sulmasy DP. Sedation, alimentation, hydration, and equivocation: careful conversation about care at the end of life. Ann Intern Med. 2002;136:845-9. [PMID: 12044133] LinkGoogle Scholar2. Quill TE, Lo B, Brock DW. Palliative options of last resort: a comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia. JAMA. 1997;278:2099-104. [PMID: 9403426] CrossrefMedlineGoogle Scholar3. Quill TE, Byock IR. Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of food and fluids. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians-American Society of Internal Medicine. Ann Intern Med. 2000;132:408-14. [PMID: 10691593] LinkGoogle Scholar4. Quill TE, Lee BC, Nunn S. Palliative treatments of last resort: choosing the least harmful alternative. University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel. Ann Intern Med. 2000;132:488-93. [PMID: 10733450] LinkGoogle Scholar5. Quill TE, Dresser R, Brock DW. The rule of double effect—a critique of its role in end-of-life decision making. N Engl J Med. 1997;337:1768-71. [PMID: 9392707] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Rochester School of Medicine; Rochester, NY 14642 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoResponding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids Timothy E. Quill , Ira R. Byock , and Palliative Treatments of Last Resort: Choosing the Least Harmful Alternative Timothy E. Quill , Barbara Coombs Lee , Sally Nunn , and Sedation, Alimentation, Hydration, and Equivocation: Careful Conversation about Care at the End of Life Lynn A. Jansen and Daniel P. Sulmasy Careful Conversation about Care at the End of Life Paul Rousseau Careful Conversation about Care at the End of Life Lynn A. Jansen and Daniel P. Sulmasy Physician Involvement in Voluntary Stopping of Eating and Drinking Bernard Gert , James L. Bernat , and R. Peter Mogielnicki Physician Involvement in Voluntary Stopping of Eating and Drinking Lynn A. Jansen and Daniel P. Sulmasy Careful Conversation about Care at the End of Life Charles G. Sasser Careful Conversation about Care at the End of Life Tatsuya Morita , Satoru Tsuneto , and Yasuo Shima Careful Conversation about Care at the End of Life John H. Kvasnicka Metrics Cited byPhysician Reports of Terminal Sedation without Hydration or Nutrition for Patients Nearing Death in the NetherlandsJudith A.C. Rietjens, MSc, Agnes van der Heide, MD, PhD, Astrid M. Vrakking, MSc, Bregje D. Onwuteaka-Philipsen, PhD, Paul J. van der Maas, MD, PhD, and Gerrit van der Wal, MD, PhD 17 December 2002Volume 137, Issue 12Page: 1009KeywordsEatingEnd of life careMotivationMusclesSedation ePublished: 17 December 2002 Issue Published: 17 December 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...