“Thou shalt not die in pain”: Treatment decisions at the end of life

 Print

Thematic : End of life / Palliative care

Studies

Published on : 01/03/2002

Author / Source : Margaret Somerville

Professor in the Faculty of Medicine
Founding Director of the Faculty of Law's Centre for Medicine,
Ethics and Law at McGill University

A recent paper, Consensus Guidelines on Analgesia and Sedation in Dying Intensive Care Unit Patients (L.A Hawryluck, W.R.C. Harvey, L. Lemieux-Charles and P.A. Singer, University of Toronto, March 2002) attracted a great deal of media attention.  In the process, some confusion about the ethics and law of treating the pain and suffering of dying people, in particular, those in intensive care units, was revealed.  So, what are the current bottom-line ethical and legal rules?

Patient-centred decisionmaking…

First, decision making about treatment must be patient-centred — in the past, it was physician-centred.  Requiring the patient's — or the incompetent patient's representative's — informed consent to giving, withholding or withdrawing treatment, ensures patient-centredness. 

At a certain point, terminally ill patients — or their representatives — will decide not to continue treatment that has a goal of prolonging life, and to change to palliative treatment that has a primary goal of treating pain and suffering.  Note: this is a decision to change the nature of the treatment received and not a decision to cease treatment or an informed refusal of treatment.  In the past, it was not uncommon for physicians to say to dying patients, “There is nothing more we can do for you”. That statement would, now, encapsulate the antithesis of good, contemporary palliative medicine. 

 

“'Thou shalt not die in pain' Treatment decisions at the end of life”, Canadian Disability, Winter 2002, 9-11.

  • euthanasia
  • palliative care

Similar articles

Belgium : a further extension of euthanasia

- Euthanasia and assisted suicide

Based on texts which have already been submitted during the previous legislature, three further proposals (put forward by Mme Karin Jiroflée et al, sp.A), seeking to modify the law of May 28, 2002 on euthanasia, have just recently been laid before the Chamber of Belgian Deputies, without any specific deadline for their adoption having for the moment been defined.

The first proposal (Doc 54 1013/001) aims to authorize the act of euthanasia for patients who are unable to express their wishes ...

Read more

Euthanasia by Confusion

- Euthanasia and assisted suicide

Professor in the Faculty of Medicine
Founding Director of the Faculty of Law's Centre for Medicine,
Ethics and Law at McGill University

Which terms are used?

Is the euthanasia debate best by confusion?

 

"Euthanasia by Confusion" (1997) 20:3  University of New South Wales Law Journal  550-575; abbreviated version also published in Policy Options, 1997, 18(10):21-24; in The Advocate, 1998, 56 (6): 875-884; in Review Catholic Health Association of Canada, 1998; 26(1):3-10

Read more

Legalizing euthanasia. Why now?

- Euthanasia and assisted suicide

Professor in the Faculty of Medicine
Founding Director of the Faculty of Law's Centre for Medicine,
Ethics and Law at McGill University

Until very recently, all countries prohibited euthanasia....

 

Somerville, Margaret, Death Talk: The Case against Euthanasia and Physician-Assisted Suicide, McGill Queen's University Press; Montreal, 2001, pp 433.  Chapter 6 reprinted in Wesley Cragg, Christine M. Koggel, Contemporary Moral Issues, 5th Ed., 2005.

Read more