End of life care conference held
Print version
Is the principle of double effect still relevant in end of life care?
A joint meeting between the Centre for Biomedicine and Society (KCL) and the Royal Society of Medicine took place on Monday 1 February at the Royal Society of Medicine.
This meeting brought together over 100 people from a wide range of disciplines, including academics from King's. It was funded by a Roberts Open (KCL) Postgraduate Grant awarded to Dr Andrew Papanikitas, a GP and CBAS PhD student. It is possibly the first UK meeting on this topic ever to bring together theologians, philosophers, lawyers, social scientists, psychologists and healthcare professionals in a collegial, interdisciplinary, non partisan manner.
In discussions of end of life decision-making the ethical or legal Doctrine of Double Effect remains a hotly debated topic. For some it is crucial to able to treat symptoms whilst acknowledging a risk or even certainty that unintended harm or death will be hastened. For others it is a distinction without difference, and either allows inappropriate mercy killing to go undetected or prevents legislation around assisted suicide to move forward.
Professor Williams commented, “This type of interdisciplinary debate is central to the ethos of CBAS.”
A joint meeting between the Centre for Biomedicine and Society (KCL) and the Royal Society of Medicine took place on Monday 1 February at the Royal Society of Medicine.
This meeting brought together over 100 people from a wide range of disciplines, including academics from King's. It was funded by a Roberts Open (KCL) Postgraduate Grant awarded to Dr Andrew Papanikitas, a GP and CBAS PhD student. It is possibly the first UK meeting on this topic ever to bring together theologians, philosophers, lawyers, social scientists, psychologists and healthcare professionals in a collegial, interdisciplinary, non partisan manner.
In discussions of end of life decision-making the ethical or legal Doctrine of Double Effect remains a hotly debated topic. For some it is crucial to able to treat symptoms whilst acknowledging a risk or even certainty that unintended harm or death will be hastened. For others it is a distinction without difference, and either allows inappropriate mercy killing to go undetected or prevents legislation around assisted suicide to move forward.
Professor Williams commented, “This type of interdisciplinary debate is central to the ethos of CBAS.”
Conclusions
The conference produced some thought provoking conclusions:
There is evidence that painkillers and sedatives (appropriately used) are safer at the end of life than the public or indeed the courts would perceive. This is particularly problematic if painkilling or sedative medications have been given in inappropriate doses, which could give rise to criminal (murder/manslaughter) or civil proceedings (negligence). The inference from the use of a painkilling drug as opposed to a non-painkilling drug that harm is not intended could be open to question by lawyers.
In web-based neuroethics experiments the public are statistically more likely to infer guilty intention from an intervention perceived as causing harm, or where the decision-maker is perceived as reckless or careless. Though principle of double effect as formulated in western medical ethics and law has roots in Roman Catholicism, double effect reasoning is present in many cultures and faiths. At the meeting Professor David Jones of the St Mary’s University College maintained that this kind of reasoning may be a necessity for individuals whose personal ethics are based on divine commandments or moral absolutes, however one does not need to subscribe to such a view in order to use such reasoning. An unintended effect of an action must be probable or certain, as well as adverse and severe enough to be distinguished from a side effect. Professor Neil Levy of Oxford University stated that data from his ongoing philosophical experiments suggested that the principle may be generally misused.
Palliative care specialists are least likely in surveys to report life-shortening interventions, but other hospital specialties and GPs are much more likely to report double effect-type decisions and have historically more often been involved in court cases.
There was widespread agreement at the day that perpetuating a myth that painkillers and sedatives were likely to hasten death (something philosophers and educators had yet to widely take on board) was potentially causing harm itself by promoting the under-treatment of pain and distress outside the palliative care setting.
There is evidence that painkillers and sedatives (appropriately used) are safer at the end of life than the public or indeed the courts would perceive. This is particularly problematic if painkilling or sedative medications have been given in inappropriate doses, which could give rise to criminal (murder/manslaughter) or civil proceedings (negligence). The inference from the use of a painkilling drug as opposed to a non-painkilling drug that harm is not intended could be open to question by lawyers.
In web-based neuroethics experiments the public are statistically more likely to infer guilty intention from an intervention perceived as causing harm, or where the decision-maker is perceived as reckless or careless. Though principle of double effect as formulated in western medical ethics and law has roots in Roman Catholicism, double effect reasoning is present in many cultures and faiths. At the meeting Professor David Jones of the St Mary’s University College maintained that this kind of reasoning may be a necessity for individuals whose personal ethics are based on divine commandments or moral absolutes, however one does not need to subscribe to such a view in order to use such reasoning. An unintended effect of an action must be probable or certain, as well as adverse and severe enough to be distinguished from a side effect. Professor Neil Levy of Oxford University stated that data from his ongoing philosophical experiments suggested that the principle may be generally misused.
Palliative care specialists are least likely in surveys to report life-shortening interventions, but other hospital specialties and GPs are much more likely to report double effect-type decisions and have historically more often been involved in court cases.
There was widespread agreement at the day that perpetuating a myth that painkillers and sedatives were likely to hasten death (something philosophers and educators had yet to widely take on board) was potentially causing harm itself by promoting the under-treatment of pain and distress outside the palliative care setting.
Web cast
The meeting will be web cast in the month after the event so that readers can experience speakers’ presentations via a web link available at: www.rsm.ac.uk/open