Abstract

HODELIN TABLADA, Ricardo. The principle of double effect on sedation of terminally ill patients. MEDISAN [online]. 2012, vol.16, n.6, pp.949-959. ISSN 1029-3019.

Among the 5 ethical principles in palliative medicine, that of the double effect or of practical reasoning is not only used to determine the licitness or illicitness of an action and can produce two effects: a good one and a bad one, but also it can be applied in terminally ill patients who usually have a severe pain, respiratory distress or other symptoms that require the use of drugs, such as morphine, which effect could lead to hypotension or respiratory depression, or other drugs that reduce the level of wakefulness or even deprive the patient of his consciousness. This paper carefully reviews the subject and the author presents his views on the matter. It is concluded that sedation of the patient is ethical only when the pain has been refractory to the treatment recommended, including different neurosurgical treatments. It is not considered acceptable to administer morphine as primary attempt to achieve death. The principle of double effect becomes unavoidable evil caused by the urgent pursuit of a good. This principle allows to perform a morally legitimate action, even when undesirable effects can be derived from it.

Keywords : terminally ill patient; bioethics; palliative care, euthanasia; limitation of the therapeutic effort; principle of double effect; sedation.

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