The role of the principle of double effect in ethics education at US medical schools and its potential impact on pain management at the end of life.

Abstract:

BACKGROUND:Because opioids can suppress respiratory drive, the principle of double effect (PDE) has been used to justify their use for terminally ill patients. Recent studies, however, suggest that the risk of respiratory depression in typical end-of-life (EOL) situations may be overstated and that heightened concern for this rare occurrence can lead to inadequate treatment of pain. The purpose of this study is to examine the role of the PDE in medical school ethics education, with specific reference to its potential impact on pain management at EOL. METHOD:After obtaining institutional review board approval, an electronic survey was sent to ethics educators at every allopathic medical school in the USA. RESULTS:One-third of ethics educators felt that opioids were 'likely' to cause significant respiratory depression that could hasten death. Educators' opinions of opioid effects did not influence their view of the relevance of the PDE, with approximately 70% deeming it relevant to EOL care. Only 15% of ethics educators believed that associating the PDE with opioid use might discourage clinicians from optimally treating pain, out of concern for respiratory depression. CONCLUSION:This study demonstrates that a significant minority of ethics educators believe, contrary to current evidence, that opioids are 'likely' to cause significant respiratory depression that could hasten death in terminally ill patients. Yet, many of those who do not feel this is likely still rely on the PDE to justify this possibility, potentially (and unknowingly) contributing to clinical misperceptions and underutilisation of opioids at EOL.

journal_name

J Med Ethics

authors

Macauley R

doi

10.1136/medethics-2011-100105

subject

Has Abstract

pub_date

2012-03-01 00:00:00

pages

174-8

issue

3

eissn

0306-6800

issn

1473-4257

pii

medethics-2011-100105

journal_volume

38

pub_type

杂志文章
  • Who should consent for research in adult intensive care? Preferences of patients and their relatives: a pilot study.

    abstract:INTRODUCTION:Research in intensive care is necessary for the continuing advancement of patient care. In research, informed consent is considered essential for patient protection. In intensive care, the modalities of informed consent are currently being debated by both lawyers and the medical community. The preferences ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2008.028068

    authors: Chenaud C,Merlani P,Verdon M,Ricou B

    更新日期:2009-11-01 00:00:00

  • Training healthcare professionals as moral case deliberation facilitators: evaluation of a Dutch training programme.

    abstract::Until recently, moral case deliberation (MCD) sessions have mostly been facilitated by external experts, mainly professional ethicists. We have developed a train the facilitator programme for healthcare professionals aimed at providing them with the competences needed for being an MCD facilitator. In this paper, we pr...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章,多中心研究

    doi:10.1136/medethics-2012-100546

    authors: Plantinga M,Molewijk B,de Bree M,Moraal M,Verkerk M,Widdershoven GA

    更新日期:2012-10-01 00:00:00

  • Attitudes toward euthanasia and physician-assisted suicide: a study of the multivariate effects of healthcare training, patient characteristics, religion and locus of control.

    abstract::Public and healthcare professionals differ in their attitudes towards euthanasia and physician-assisted suicide (PAS), the legal status of which is currently in the spotlight in the UK. In addition to medical training and experience, religiosity, locus of control and patient characteristics (eg, patient age, pain leve...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2012-100729

    authors: Hains CA,Hulbert-Williams NJ

    更新日期:2013-11-01 00:00:00

  • Analogy in moral deliberation: the role of imagination and theory in ethics.

    abstract::This paper develops themes addressed in an article by Eric Wiland in the Journal of Medical Ethics 2000;26:466-8, where he aims to contribute to the debate concerning the moral status of abortion, and to emphasise the importance of analogies in moral argument. In the present paper I try to secure more firmly a novel u...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/jme.28.4.244

    authors: Smith B

    更新日期:2002-08-01 00:00:00

  • The Groningen Protocol for newborn euthanasia; which way did the slippery slope tilt?

    abstract::In The Netherlands, neonatal euthanasia has become a legal option and the Groningen Protocol contains an approach to identify situations in which neonatal euthanasia might be appropriate. In the 5 years following the publication of the protocol, neither the prediction that this would be the first step on a slippery sl...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2013-101402

    authors: Verhagen AA

    更新日期:2013-05-01 00:00:00

  • Sexual rights puzzle: re-solved?

    abstract::My sexual rights puzzle according to which positive sexual rights are not compatible with negative sexual rights has been recently criticised in the Journal of Medical Ethics by Steven J Firth, who has put forward three objections to the puzzle. In this brief response, I analyse and reject each of these three objectio...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/medethics-2019-105642

    authors: Di Nucci E

    更新日期:2020-05-01 00:00:00

  • Differences in medical students' attitudes to academic misconduct and reported behaviour across the years--a questionnaire study.

    abstract:OBJECTIVES:This study aimed to determine attitudinal and self reported behavioural variations between medical students in different years to scenarios involving academic misconduct. DESIGN:A cross-sectional study where students were given an anonymous questionnaire that asked about their attitudes to 14 scenarios desc...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.29.2.97

    authors: Rennie SC,Rudland JR

    更新日期:2003-04-01 00:00:00

  • Cancer Research UK'S obesity campaign in 2018 and 2019: effective health promotion or perpetuating the stigmatisation of obesity?

    abstract::In 2018 and 2019 Cancer Research UK (CRUK) launched a controversial advertising campaign to inform the British public of obesity being a preventable cause of cancer. On each occasion the advertisements used were emotive and provoked frustration among the British public which was widely vocalised on social media. As we...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2020-106192

    authors: Varshney N

    更新日期:2020-11-25 00:00:00

  • The Market View on conscientious objection: overvalued.

    abstract::Ancell and Sinnott-Armstrong argue that medical providers possess wide freedoms to determine the scope of their practice, and therefore, prohibiting almost any conscientious objections is a bad idea. They maintain that we could create an acceptable system on the whole which even grants accommodations to discriminatory...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2018-105173

    authors: Card RF

    更新日期:2019-03-01 00:00:00

  • Ethical considerations in international HIV vaccine trials: summary of a consultative process conducted by the Joint United Nations Programme on HIV/AIDS (UNAIDS).

    abstract::Research that is initiated, designed or funded by sponsor agencies based in countries with relatively high social and economic development, and conducted in countries that are relatively less developed, gives rise to many important ethical challenges. Although clinical trials of HIV vaccines began ten years ago in the...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.26.1.37

    authors: Guenter D,Esparza J,Macklin R

    更新日期:2000-02-01 00:00:00

  • Labelling of end-of-life decisions by physicians.

    abstract:OBJECTIVES:Potentially life-shortening medical end-of-life practices (end-of-life decisions (ELDs)) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices (described according to the precise act, the intention, the presence of an expli...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2013-101854

    authors: Deyaert J,Chambaere K,Cohen J,Roelands M,Deliens L

    更新日期:2014-07-01 00:00:00

  • What is the role of clinical ethics support in the era of e-medicine?

    abstract::The internet is becoming increasingly important in health care practice. The number of health-related web sites is rising exponentially as people seek health-related information and services to supplement traditional sources, such as their local doctor, friends, or family. The development of e-medicine poses important...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.27.suppl_1.i33

    authors: Parker M,Gray JA

    更新日期:2001-04-01 00:00:00

  • Camouflage is no defence--a response to Kottow.

    abstract::The author responds to Professor Kottow's criticisms, explaining numerous errors and misconceptions. ...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/jme.25.4.344

    authors: Seedhouse D

    更新日期:1999-08-01 00:00:00

  • The burden of normality: from 'chronically ill' to 'symptom free'. New ethical challenges for deep brain stimulation postoperative treatment.

    abstract::Although an invasive medical intervention, Deep Brain Stimulation (DBS) has been regarded as an efficient and safe treatment of Parkinson's disease for the last 20 years. In terms of clinical ethics, it is worth asking whether the use of DBS may have unanticipated negative effects similar to those associated with othe...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2011-100044

    authors: Gilbert F

    更新日期:2012-07-01 00:00:00

  • Killing or letting die? Proposal of a (somewhat) new answer to a perennial question.

    abstract::There is as yet no widely agreed-upon solution to the standard textbook problem whether actively shutting off a life-sustaining medical device, e.g. a respirator, and thus bringing about a patient's death amounts to active killing or just to an omission of further treatment. Apart from a range of astutely contrived ca...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2016-103495

    authors: Merkel R

    更新日期:2016-06-01 00:00:00

  • Acceptability of compulsory powers in the community: the ethical considerations of mental health service users on Supervised Discharge and Guardianship.

    abstract:OBJECTIVES:To explore mental health service users' views of existing and proposed compulsory powers. DESIGN:A qualitative study employing in-depth interviews. Participants were asked to respond to hypothetical questions regarding the application of compulsory powers under the Mental Health Act 1983 for people other th...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章,评审

    doi:10.1136/jme.2003.004861

    authors: Canvin K,Bartlett A,Pinfold V

    更新日期:2005-08-01 00:00:00

  • Towards a specific approach to education in dental ethics: a proposal for organising the topics of biomedical ethics for dental education.

    abstract::Understanding dental ethics as a field separate from its much better known counterpart, medical ethics, is a relatively new, but necessary approach in bioethics. This need is particularly felt in dental education and establishing a curriculum specifically for dental ethics is a challenging task. Although certain topic...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2011-100067

    authors: Gorkey S,Guven T,Sert G

    更新日期:2012-01-01 00:00:00

  • Reproductive tourism as moral pluralism in motion.

    abstract::Reproductive tourism is the travelling by candidate service recipients from one institution, jurisdiction, or country where treatment is not available to another institution, jurisdiction, or country where they can obtain the kind of medically assisted reproduction they desire. The more widespread this phenomenon, the...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.28.6.337

    authors: Pennings G

    更新日期:2002-12-01 00:00:00

  • Ethical aspects of research into Alzheimer disease. A European Delphi Study focused on genetic and non-genetic research.

    abstract:BACKGROUND:Although genetic research into Alzheimer disease (AD) is increasing, the ethical aspects of this kind of research and the differences between ethical issues related to genetic and non-genetic research into AD have not yet received much attention. OBJECTIVES:(1) To identify and compare the five ethical issue...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2008.025049

    authors: van der Vorm A,Vernooij-Dassen MJ,Kehoe PG,Olde Rikkert MG,van Leeuwen E,Dekkers WJ

    更新日期:2009-02-01 00:00:00

  • Fair and equitable subject selection in concurrent COVID-19 clinical trials.

    abstract::Clinical trials emerged in rapid succession as the COVID-19 pandemic created an unprecedented need for life-saving therapies. Fair and equitable subject selection in clinical trials offering investigational therapies ought to be an urgent moral concern. Subject selection determines the distribution of risks and benefi...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2020-106590

    authors: Jansen MO,Angelos P,Schrantz SJ,Donington JS,Madariaga MLL,Zakrison TL

    更新日期:2021-01-01 00:00:00

  • Comments on an obstructed death -- a case conference revisited: commentary 1.

    abstract::The paper comments on Scott Dunbar's "An obstructed death and medical ethics," arguing contra Dunbar that we should not view truth-telling to the terminally ill as primarily governed by principles of veracity and respect for autonomy. All such rules are of limited value in medical ethics. We should instead turn to a...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.16.2.88

    authors: Byrne P

    更新日期:1990-06-01 00:00:00

  • Dealing with the brain-damaged old--dignity before sanctity.

    abstract::The present and future rapid increase in the hospital population of geriatric patients is discussed with particular reference to the problem of advanced brain degeneration. The consequences of various clinical management options are outlined and it is suggested that extreme attempts either to preserve or terminate lif...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.8.4.173

    authors: Robertson GS

    更新日期:1982-12-01 00:00:00

  • Sturdy for common things: cultivating moral sensemaking on the front lines of practice.

    abstract::This essay argues that the field of bioethics should concern itself especially with the process of making moral sense that unfolds among clinicians, patients and family members during common but high-stakes conversations occurring on the front lines of practice. The essay outlines the parameters of a bioethics grounde...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2011-100084

    authors: Browning DM

    更新日期:2012-04-01 00:00:00

  • What about the dentist-patient relationship in dental tourism?

    abstract::Dental tourism is patients travelling across international borders with the intention of receiving dental care. It is a growing phenomenon that raises many ethical issues, particularly regarding the dentist-patient relationship. We discuss various issues related to this phenomenon, including patient autonomy over prac...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2013-101415

    authors: Conti A,Delbon P,Laffranchi L,Paganelli C

    更新日期:2014-03-01 00:00:00

  • The criminalisation of HIV transmission.

    abstract::Since Bennett, Draper, and Frith published a paper in this journal in 2000 considering the possible criminalisation of HIV transmission, an important legal development has taken place. February 2001 saw the first successful United Kingdom prosecution for the sexual transmission of disease for over a century, when Step...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/jme.28.3.160

    authors: Chalmers J

    更新日期:2002-06-01 00:00:00

  • Evidence of broad-based family support for the use of archival childhood tumour samples in future research.

    abstract:OBJECTIVES:This study aimed to determine the ability to successfully contact past paediatric patients and their families to request participation in research, to assess familial views on the use of previously collected archival clinical samples for research purposes, and to highlight the ethical and practical issues in...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2015-103141

    authors: Sexton-Oates A,Dodgshun A,MacGregor D,Ludlow LE,Sullivan M,Saffery R

    更新日期:2016-07-01 00:00:00

  • A quiet revolution in organ transplant ethics.

    abstract::A quiet revolution is occurring in the field of transplantation. Traditionally, transplants have involved solid organs such as the kidney, heart and liver which are transplanted to prevent recipients from dying. Now transplants are being done of the face, hand, uterus, penis and larynx that aim at improving a recipien...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2015-103348

    authors: Caplan A,Purves D

    更新日期:2017-11-01 00:00:00

  • The placebo effect in psychiatry: problem or solution?

    abstract::This opinion piece aims to situate the placebo effect within the field of psychiatric treatment. To accomplish this, the placebo is explored at the centre of an often heated debate between three discrete perspectives: the clinical trial researcher, the placebo researcher and the clinician. Each occupational perspectiv...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2013-101410

    authors: Huculak S

    更新日期:2014-06-01 00:00:00

  • Learning about death: a project report from the Edinburgh University Medical School.

    abstract::A report of a problem-based learning project on the ethics of terminal care, offered as one of the options available to first year MB ChB students in Edinburgh University Medical School. The project formed part of the 'clinical correlation course' in the new curriculum. Six students took part under the supervision of ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.7.2.62

    authors: Thompson IE,Lowther CP,Doyle D,Bird J,Turnbull J

    更新日期:1981-06-01 00:00:00

  • Legitimate requests and indecent proposals: matters of justice in the ethical assessment of phase I trials involving competent patients.

    abstract::The death of Jesse Gelsinger in 1999 during a gene therapy trial raised many questions about the ethical review of medical research. Here, the author argues that the principle of justice is interpreted too narrowly and receives insufficient emphasis and that what we permit in terms of bodily invasion affects the value...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2003.006684

    authors: Kong WM

    更新日期:2005-04-01 00:00:00