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Physicians' practices related to the use of terminal sedation: Moral and ethical concerns

Published online by Cambridge University Press:  01 March 2004

SHERRY C. POMERANTZ ,
HIMANI BHATT ,
NANCY L. BRODSKY ,
DEBORAH LURIE ,
JANICE CIESIELSKI  and
THOMAS A. CAVALIERI
SHERRY C. POMERANTZ
Affiliation:
University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine, Department of Medicine, Stratford, New Jersey
HIMANI BHATT
Affiliation:
University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine, Department of Medicine, Stratford, New Jersey
NANCY L. BRODSKY
Affiliation:
The Children's Hospital of Philadelphia, Department of Neonatology, Philadelphia, Pennsylvania
DEBORAH LURIE
Affiliation:
Saint Joseph's University, Department of Mathematics and Computer Science, Philadelphia, Pennsylvania
JANICE CIESIELSKI
Affiliation:
University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine, Department of Medicine, Stratford, New Jersey
THOMAS A. CAVALIERI
Affiliation:
University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine, Department of Medicine, Stratford, New Jersey
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Abstract

Objective: Although terminal sedation (TS) has generally been seen as legal and ethically acceptable, ethical and moral issues remain. Little is known about the use of TS in general clinical practice and about how TS is viewed by physicians, given moral and ethical concerns. The objectives of this study are (1) to describe attitudes of physicians regarding terminal sedation; (2) to explore demographic characteristics, such as age, gender, subspecialty, and number of years in practice, that might be related to the use of TS; and (3) to compare physicians who have and have not used TS on the degree to which they view TS as moral and consistent with their professional and personal ethics.

Methods: An anonymous survey of New Jersey physicians was conducted at the University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine. A 39-item questionnaire assessing general opinions about, experiences with, and religious, moral, ethical attitudes toward TS and other end-of-life treatments was utilized.

Results: A majority of physicians (73%) had used TS for a patient. Most (93%) said there were circumstances under which they would use TS. With regard to questions about whether TS would be “immoral,” “would violate my religious beliefs,” “would violate my professional ethics” and “is inconsistent with the physician's role of preserving life,” approximately 55% of those who have used TS disagreed; for those who have not used TS, approximately 35% disagreed.

Significance of results: Professional education and opportunities for discussion appear necessary to help reconcile the conflicts raised in the use of this end-of-life treatment strategy.

Keywords

Terminal sedationEnd-of-life carePhysician decision-making
Type
Research Article
Information
Palliative & Supportive Care , Volume 2 , Issue 1 , March 2004 , pp. 15 - 21
Copyright
© 2004 Cambridge University Press

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References

REFERENCES

Beauchamp, T.L. & Childress, J.F. (2001). Principles of Biomedical Ethics. New York: Oxford University Press.
Burt, R.A. (1997). The Supreme Court speaks: Not assisted suicide but a constitutional right to palliative care. New England Journal of Medicine, 337, 1234–1236.Google Scholar
Cavalieri, T.A., Pomerantz, S.C., Ciesielski, & J., et al. (2002). Attitudes of osteopathic physicians toward physician assisted suicide. Journal of the American Osteopathic Association, 102, 27–34.Google Scholar
Goold, S.D., Arnold, R.M., & Siminoff, L.A. (1993). Discussions about limiting treatment in a geriatric clinic. Journal of the American Geriatrics Society, 41, 277–281.Google Scholar
Jansen, L.A. & Sulmasy, D.P. (2002). Sedation, alimentation, hydration, and equivocation: Careful conversation about care at the end of life. Annals of Internal Medicine, 136, 845–849.Google Scholar
Lee, M.A., Nelson, H.D., Tilden, & V.P., et al. (1996). Legalizing assisted suicide: Views of physicians in Oregon. New England Journal of Medicine, 334, 310–315.Google Scholar
Metzger, M. & Orloff Kaplan, K. (2001). Transforming Death in America. Report Summary. Washington DC: Last Acts.
Quill, T.E. & Byock, I.R. (2000). Responding to intractable terminal suffering: The role of terminal sedation and voluntary refusal of foods and fluids. Annals of Internal Medicine, 132, 408–414.Google Scholar
Quill, T.E., Lee, B.C., & Nunn, S. (2000). Palliative treatments of last resort: Choosing the least harmful alternative. Annals of Internal Medicine, 132, 488–493.Google Scholar
Quill, T.E., Lo, B., & Brock, D.W. (1997). Palliative options of last resort: A comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia. JAMA, 278, 2099–2104.Google Scholar
Schuit, K.W., Bender, W., Meijler, & W.J., et al. (1999). Learning effects of a workshop in palliative cancer care for general practitioners. Journal of Cancer Education, 14, 18–22.Google Scholar
Vacco v. Quill, 117 S.Ct 2293 (1997).
Washington v. Glucksberg, 117 S.Ct. 2258 (1997).