Justifying Different Levels of Palliative Sedation
Authors: Daniel P. Sulmasy
Journal: Annals of Internal Medicine (2010)

Letters2 March 2010Justifying Different Levels of Palliative SedationDaniel P. Sulmasy, MD, PhD, Farr Curlin, MD, Gerard S. Brungardt, MD, and Thomas Cavanaugh, PhDDaniel P. Sulmasy, MD, PhDFrom University of Chicago, Chicago, IL 60637; University of Kansas, Wichita, Wichita, KS 67202; and University of San Francisco, San Francisco, CA 94117., Farr Curlin, MDFrom University of Chicago, Chicago, IL 60637; University of Kansas, Wichita, Wichita, KS 67202; and University of San Francisco, San Francisco, CA 94117., Gerard S. Brungardt, MDFrom University of Chicago, Chicago, IL 60637; University of Kansas, Wichita, Wichita, KS 67202; and University of San Francisco, San Francisco, CA 94117., and Thomas Cavanaugh, PhDFrom University of Chicago, Chicago, IL 60637; University of Kansas, Wichita, Wichita, KS 67202; and University of San Francisco, San Francisco, CA 94117.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-5-201003020-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We are curious about the repeated invocation by Quill and colleagues (1) of double-effect reasoning regarding palliative sedation. Double-effect reasoning crucially involves the distinction between what one foresees and what one intends, as well as the ability to make a proportionate judgment about the good and bad outcomes of an action (2, 3). Inexplicably, 2 of the authors have elsewhere rejected double-effect reasoning at the end of life (4); nonetheless, they explicitly cite this article to support the application of double effect to palliative sedation. They now write, "Occasionally, PPS requires sedation to unconsciousness, which is considered ...References1. Quill TE, Lo B, Brock DW, Meisel A. Last-resort options for palliative sedation. Ann Intern Med. 2009;151:421-4. [PMID: 19755367] LinkGoogle Scholar2. Sulmasy DP. "Re-inventing" the rule of double effect.. In: Steinbock B, eds. The Oxford Handbook of Bioethics. Oxford: Oxford Univ Pr; 2007:114-49. Google Scholar3. Cavanaugh TE. Double effect reasoning: doing good and avoiding evil. New York: Oxford Univ Pr; 2006. Google Scholar4. 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 Scholar5. 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 Scholar Author, Article, and Disclosure InformationAffiliations: From University of Chicago, Chicago, IL 60637; University of Kansas, Wichita, Wichita, KS 67202; and University of San Francisco, San Francisco, CA 94117.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSedation, Alimentation, Hydration, and Equivocation: Careful Conversation about Care at the End of Life Lynn A. Jansen and Daniel P. Sulmasy Last-Resort Options for Palliative Sedation Timothy E. Quill , Bernard Lo , Dan W. Brock , and Alan Meisel Justifying Different Levels of Palliative Sedation Timothy E. Quill , Daniel Brock , Bernard Lo , and Alan Meisel Justifying Different Levels of Palliative Sedation Victor Cellarius and Blair Henry Metrics Cited ByThe last low whispers of our dead: when is it ethically justifiable to render a patient unconscious until death?Pediatrician Ambiguity in Understanding Palliative Sedation at the End of LifePalliative sedation, foregoing life-sustaining treatment, and aid-in-dying: what is the difference?Intentional Sedation to Unconsciousness at the End of Life: Findings From a National Physician SurveyPalliative Sedation: Reliability and Validity of Sedation Scales 2 March 2010Volume 152, Issue 5Page: 332-333KeywordsConflicts of interestEuthanasiaFoodMouthReasoningSedation ePublished: 2 March 2010 Issue Published: 2 March 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...