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Refractory Pain, Existential Suffering, and Palliative Care: Releasing an Unbearable Lightness of Being


George P. Smith II


Catholic University of America (CUA) - Columbus School of Law

March 1, 2011

Cornell Journal of Law and Public Policy, Vol. 20, No. 3, pp. 469-532, 2011
CUA Columbus School of Law Legal Studies Research Paper No. 2011-7

Abstract:     
Since the beginning of the hospice movement in 1967, “total pain management” has been the declared goal of hospice care. Palliating the whole person’s physical, psycho-social, and spiritual states or conditions is central to managing the pain which induces suffering. At the end-stage of life, an inextricable component of the ethics of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. This Article urges wider consideration and use of terminal sedation, or sedation until death, as an efficacious palliative treatment and as a reasonable medical procedure in order to safeguard the “right” to a dignified death.

Once the state establishes a human right to avoid refractory pain of whatever nature in end-stage illness, a co-ordinate responsibility must be assumed by health care providers to make medical judgments consistent with preserving the best interests of a patient’s quality of life by alleviating suffering. The principle of medical futility is the preferred construct for implementing this professional responsibility.

Rather than continue to be mired in the vexations quagmire of the doctrine of double effect – all in an effort to “test” whether end-stage decisions by health care providers are licit or illicit – a relatively simple test of proportionality, or cost-benefit analysis, is proffered. Imbedded, necessarily, in this equation is the humane virtue of compassion, charity, mercy or agape.

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Date posted: April 7, 2011  

Suggested Citation

Smith, George P., Refractory Pain, Existential Suffering, and Palliative Care: Releasing an Unbearable Lightness of Being (March 1, 2011). Cornell Journal of Law and Public Policy, Vol. 20, No. 3, pp. 469-532, 2011; CUA Columbus School of Law Legal Studies Research Paper No. 2011-7. Available at SSRN: http://ssrn.com/abstract=1804326

Contact Information

George P. Smith II (Contact Author)
Catholic University of America (CUA) - Columbus School of Law ( email )
3600 John McCormack Rd., NE
Washington, DC 20064
United States
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