Image: Medieval Arab philosopher Avicenna. Wikimedia Commons.

Ethics of Palliative Care

In this section, we tackle the challenging topics of withholding/withdrawing treatments, palliative sedation, physician-assisted death & euthanasia. We will review definitions, ethics, legal issues, communication, and specific treatment. 

Some topics we will review include:
  1. Until not long ago, withholding or withdrawing care was exceedingly controversial.  We will review this history and key cases.  How do these options affect people of different ages and capacity?
  2. Palliative Sedation: What is it?  When is it used?  What considerations should one make?  What is the procedure? 
  3. Physician-assisted death (PAD): What is it?  What about the history of PAD? What are the different religious and ethical considerations?  What can we learn from the Oregon data? How do you respond when a patient asks for help in dying? 
  4. Euthanasia: How does this differ from PAD?  Why is Canada considering including euthanasia in its PAD laws?  How does euthanasia differ from practices that involve the Principle of Double Effect?
  5. In Massachusetts, a Death with Dignity Act Petition has been signed by Martha Coakley, the Attorney General of the State and signatures are being sought to allow the bill to be submitted for discussion and vote.  The Massachusetts Medical Society is considering their position on the matter.  What is happening in the state?  What about other states?
Discussion and debate are encouraged – and given the nature of some of these topics, recognize that good, conscientious folk sit on both sides of many of these issues.  Please respect the point of view of one another.  

Articles

Physician-Aided Death
  • Quill TE, Cassel CK. Professional Organizations' Position Statements on Physician-Assisted Suicide: A Case for Studied Neutrality. Annals of Internal Medicine 2003 138(3): 208-211. link to abstract
  • AAHPM Position Statement on Physician-Assisted Death: link to fulltext
  • Oregon Public Health Division - Oregon’s Death with Dignity Act‐‐2010 link to fulltext
  • Rodriguez Davila, S. L., Vidal, E., Stewart, J. T., & Caserta, M. T. (2010). Management of a request for physician-assisted suicide. The American journal of hospice & palliative care, 27(1), 63-5. doi:10.1177/1049909109341874 link
  • Juth, N., Lindblad, A., Lynöe, N., Sjöstrand, M., & Helgesson, G. (2010). European Association for Palliative Care (EAPC) framework for palliative sedation: an ethical discussion. BMC palliative care, 9, 20. doi:10.1186/1472-684X-9-20 link to fulltext
  • Pearlman, R. A., Hsu, C., Starks, H., Back, A. L., Gordon, J. R., Bharucha, A. J., Koenig, B. A., et al. (2005). Motivations for physician-assisted suicide. Journal of general internal medicine, 20(3), 234-9. doi:10.1111/j.1525-1497.2005.40225.x link to fulltext
  • Quill, T. E., & Greenlaw, J. (2011). Physician Assisted Death. Hastings Center. Link to fulltext 

Palliative Sedation:
  • Cassell, E. J., & Rich, B. A. (2010). Intractable end-of-life suffering and the ethics of palliative sedation. Pain medicine (Malden, Mass.), 11(3), 435-8. doi:10.1111/j.1526-4637.2009.00786.x link to abstract
  • Quill, T. E., & Byock, I. R. (2000). 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. Annals of internal medicine, 132(5), 408-14. Link to abstract

Podcasts

Midwife to the Dying - On Being Krista Tippett interviews Joan Halifax in reflection of Teri Shaivo case