Journal of medical ethics
-
Journal of medical ethics · Mar 2012
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.
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. ⋯ 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 of medical ethics · Mar 2012
Provider, patient and public benefits from a NICE appraisal of bevacizumab (Avastin).
There are several good reasons for the UK Department of Health to recommend the appraisal of bevacizumab for the treatment of eye conditions by the National Institute for Health and Clinical Excellence. These reasons will extend to other drugs when similar situations arise in the future.