Intractable Pain, Palliative Management and the Principle of Medical Futility

Abstract

This monograph examines the issue of existential or psychological pain and how, heretofore, it has been dealt with by hospice or palliative care - concluding, as such, that terminal or deep sedation should be embraced more widely within the Ethic of Adjusted Care as a part of the compassionate management of the dying.

The first element of palliative treatment in hospice care is symptom control - pharmacological and psychological - in the dying patient. Today, pain relief - be it physical, mental, social or spiritual - is being recognized more and more as a fundamental human right. If voluntary refusals by competent dying patients of hydration and nutrition are tolerated routinely by both the legal and medical professions, as well as society at large - even though these actions hasten death - then, surely, under the Doctrine of Mercy and/or Principle of Beneficence, assistance in relieving chronic, irremediable pain should be allowed when requested.

The Principle of Medical Futility, supplemented by the Doctrine of Double Effect, can serve as a decisive tool for both physicians and judges when called upon to evaluate end-of-life care. If a patient is in a futile condition, efficacious treatment should be given even if the secondary effect of that assistance means hastening life's cruel and inhumane ending. Terminal sedation is just that: recognized treatment. It should not be confused, taxonomically, by denominating it as euthanasia, murder, or assisted suicide. Rather, it is but an act of self-determination.

The time has come to step outside the mired and endless moral argumentation over the "slippery slope consequence" of validating a right, however exercised, to a good (painless) death and acknowledge - decisively - that standards of common decency, compassion and mercy demand nothing less.