Journal of pain and symptom management
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J Pain Symptom Manage · Oct 1996
ReviewThe ethics of death-hastening or death-causing palliative analgesic administration to the terminally ill.
Double-effect reasoning is a nonconsequentialist analysis of a hard ethical case. In a hard ethical case, one can achieve some good end only if one also causes harm. Sometimes palliative analgesic administration to a terminally ill patient is a hard ethical case, for by it one relieves pain or distress while unavoidably hastening or causing the patient's death. Is it ethically in the clear to administer an analgesic to relieve pain or distress knowing that one will hasten or cause the patient's death? Using double-effect reasoning, the author argues that death-hastening or death-causing palliative analgesic administration to a terminally ill patient is sometimes ethically in the clear and, at times, even obligatory.
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J Pain Symptom Manage · Oct 1996
Clinical TrialEffects of intrathecal baclofen on chronic spinal cord injury pain.
The pain of 16 patients with spasticity secondary to spinal cord injury was assessed prior to intrathecal baclofen pump implantation and again 6 and 12 months postoperatively. Chronic pain was delineated into neurogenic and musculoskeletal components, noting changes in nature, quality, and severity of pain (visual analogue scale) and use of analgesic medications. Twelve of 16 patients had chronic pain preoperatively and were included in the study. ⋯ Postoperatively, at both 6- and 12-month intervals, seven patients with neurogenic pain (78%) demonstrated no significant change in pain severity, while in five patients (83%) musculoskeletal pain decreased significantly. Two patients with neurogenic pain (22%) demonstrated an increase in pain severity at both 6- and 12-month intervals. This study suggests that intrathecal baclofen reduces chronic musculoskeletal pain associated with spasticity but does not decrease chronic neurogenic spinal cord injury pain.
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J Pain Symptom Manage · Oct 1996
Death rattle: an audit of hyoscine (scopolamine) use and review of management.
This study investigated the pattern and determinants of hyoscine (scopolamine) use for death rattle by a retrospective analysis of 100 consecutive deaths in a 22-bed hospice. Patient diagnoses, duration of stay, and doses and route of administration of hyoscine used in the final 48 hr before death were recorded. ⋯ Response to hyoscine appears to be variable, and a distinction is proposed between death while due to salivary secretions (type 1) and that due to bronchial secretions (type 2) to explain the observed patterns of use. It is likely that hyoscine is more efficacious in treating type 1 death rattle than it is in treating type 2 death rattle.