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The Devil's Choice: Re-Thinking Law, Ethics and Symptom Relief in Palliative Care


Roger Magnusson


University of Sydney - Faculty of Law


Journal of Law, Medicine and Ethics, Vol. 34, No. 3, Fall 2006
Sydney Law School Research Paper No. 06/22

Abstract:     
It is often assumed, explicitly or implicitly, that the role of medical law and of medical ethics is to guide us towards the "right choice". In this article, I introduce the notion of the "devil's choice": a choice that arises in circumstances where all the options available to the decision-maker are not only unpalatable and unwanted, but are morally perverse to a greater or lesser degree. I use the notion of the devil's choice to re-interpret the conventional legal and ethical account of the provision of symptom relief in palliative care, as illustrated by judgments from the United Kingdom and the United States. In particular, I am critical of the principle of double effect and the moral distinction it seeks to draw between foreseeing, and intending, the consequences of one's actions. The benefit of applying the devil's choice to palliative care is that it permits empathy with the dilemmas physicians face, while still acknowledging the extraordinary power that physicians have over the lives of their patients. Consistent with the devil's choice, I propose requirements for a legal defense of "necessity", where palliative interventions shorten a patient's life.

Number of Pages in PDF File: 29

Keywords: pain, palliative care, sedation, criminal liability, double effect, intention, foresight,

JEL Classification: K14, K42, I12,

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Date posted: May 17, 2006  

Suggested Citation

Magnusson, Roger, The Devil's Choice: Re-Thinking Law, Ethics and Symptom Relief in Palliative Care. Journal of Law, Medicine and Ethics, Vol. 34, No. 3, Fall 2006; Sydney Law School Research Paper No. 06/22. Available at SSRN: http://ssrn.com/abstract=901560

Contact Information

Roger Magnusson (Contact Author)
University of Sydney - Faculty of Law ( email )
Faculty of Law Building, F10
The University of Sydney
Sydney, NSW 2006
Australia
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