Journal of Medical Ethics 46 (1):48-50 (2020)

Authors
Robert George
Durham University
Guy Schofield
Bristol University
Abstract
We read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper’s conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. Opiophobia makes clinicians reluctant to prescribe and their patients reluctant to take opioids that might provide significant improvements in quality of life. We argue that the evidence base for the safety of opioid prescribing is broader than that presented, restricting the search to palliative care literature produces significant bias as safety experience and literature for opioids and sedatives exists in many fields. This is not acknowledged in the synthesis presented. By considering additional evidence, we reject the need for agnosticism and reaffirm that palliative opioid prescribing is safe. Second, palliative sedation in a clinical context is a poorly defined concept covering multiple interventions and treatment intentions. We detail these and show that continuous deep palliative sedation is a specific practice that remains controversial globally and is not considered routine practice. Rejecting agnosticism towards opioids and excluding CDPS from the definition of routine care allows the rejection of Riisfeldt’s headline conclusion. On these grounds, we reaffirm the important distinction between palliative care prescribing and euthanasia in practice.
Keywords No keywords specified (fix it)
Categories (categorize this paper)
DOI 10.1136/medethics-2018-105256
Options
Edit this record
Mark as duplicate
Export citation
Find it on Scholar
Request removal from index
Revision history

Download options

PhilArchive copy


Upload a copy of this paper     Check publisher's policy     Papers currently archived: 68,916
Through your library

References found in this work BETA

Add more references

Citations of this work BETA

The Concise Argument.Lucy Frith - 2020 - Journal of Medical Ethics 46 (1):1-2.

Add more citations

Similar books and articles

Palliative Care and Euthanasia.Bert Broeckaert & Rien Janssens - 2002 - Ethical Perspectives 9 (2):156-175.

Analytics

Added to PP index
2019-06-21

Total views
41 ( #274,070 of 2,497,979 )

Recent downloads (6 months)
4 ( #171,501 of 2,497,979 )

How can I increase my downloads?

Downloads

My notes