I'm currently a 1st year medical student and wanted some Q&A responses on this. Is it morally permissible to provide lots of morphine to a patient during the last week of life knowing that the administration of the pain-killer could very well result in a 'sooner death' (as in 5 days instead of 7 days). Let it be known that I'm not asking a question about physician assisted suicide in the sense of pre-empted 'mercy killing.' Rather I wonder if it is morally permissible to administer a pain relief drug knowing it will likely limit the length of life in a terminally ill (will die within a week or two) patient if the purpose and intent is to ease the suffering as much as possible?

Thanks,

Todd W.

This is a very interesting area and it may be good to have a discussion in the debate thread.

A physician seeks to alleviate a patient's pain by administering the painkiller morphine but recognizes that the dosage is likely to shorten the patient's life. The physician regrets this result but can avoid it only by so reducing the dosage that the chemical will not have sufficient painkilling effect.... The physician expects to kill but does not intend to do so ....

The Principle of the Double Effect (PDE) provides that an action with both a good and a bad effect is ethically permissible if the following conditions are met:

1. The action itself must be morally good or at least indifferent.

2. Only the good effect must be intended (even though the bad or secondary effect is foreseen).

3. The good effect must not be achieved by way of the bad effect.

4. The good result must outweigh the bad result.

The double effect of pain medication is a recurring theme in articles discussing end-of-life issues. According to many commentators, the use of medication to treat pain and other symptoms in terminally ill patients may "hasten death," "potentially" hasten death, "actually speed up the process of dying," or "indirectly and unintentionally contribute to a patient's death." One commentator even stated that in some cases, the unintended hastening of death is the "unavoidable, known, and accepted consequence" of pain medication. Another stated that the "unavoidable and accepted consequence of [medication] may be to hasten death."

Pain is one of the most feared consequences of cancer, and patients have reason to "fear that needless suffering will be allowed to occur." Often it is the inadequate management of pain or fear of future unrelieved pain that leads to suicide ideation or the request for euthanasia. And it is the fear of unrelieved pain that drives public support for assisted-suicide and euthanasia. But as noted by Foley, "treatment of pain is never a form of euthanasia." In end-of-life discussions, focusing on the PDE and on a seldom occurring side-effect of pain medications diverts attention from the larger ethical issue of the undertreatment of pain and suffering in the dying patient. It is important that ethical analysis be grounded in medical reality.