Ethical and Legal Solution

A doctrine yet to be fully discussed is that of double effect. According to Fry, Veatch, & Taylor (2011), this idea proposes that harm, even death, is ethically sound when the act in itself is not bad, the intention is good, the harm is not a means to the good, and there is a proportionally significant cause to permit the harm. Double effect in essence tells us that if there is not a direct intention to hasten death, then it does not violate the principle of non-maleficence. The Harvard Community Ethics Committee examined the practice of palliative sedation, what they termed continuous deep sedation (CDS), and concluded that it was an appropriate end of life treatment option when terminally ill patients’ were suffering from pain otherwise unable to be relieved (Powers & McLean, 2011). Moreover, the United States Supreme Court has upheld rulings in support of palliative sedation, patients willing (Washington v. Glucksberg, 1997). Karen might be reassured by these findings and ideas. Understanding the law and searching out intelligent discussions related to the ethical concerns in this matter is important. What if she still feels uneasy, though? Palliative sedation can easily be argued against when attempting to place meaning on the ambiguous idea of intention, as intention can be very complex. The solution to this issue must be addressed with clear clinical guidelines that can direct Karen in how to proceed and that will form the basis of protection against litigation. These guidelines must include, at a minimum (Parker, Paine, & Parker, 2011):
(1) Detailed steps to ensure adequate informed consent is obtained.
(2) A process by which careful collaborative examination by a palliative specialist team is established in cases where palliative sedation is an option or request.
(3) Carefully determined criterion for patients to meet in order to qualify for the practice such as terminal illness and pain unrelieved with other aggressive treatments.
(4) Clear documentation that the intent of this practice is to relieve suffering and pain, not hasten death.
(5) Assurance that palliative sedation is used as a last resort only.