Kindgo
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Monday, September 16, 2002
BY TOM COHEN
ASSOCIATED PRESS
TORONTO -- Doctors in intensive care units can face a troubling choice -- whether to let dying patients suffer in pain or prescribe high levels of painkillers or sedatives that could hasten death, raising suspicions of euthanasia or mercy killing.
Proposed guidelines to be announced today by researchers at the University of Toronto Joint Center for Bioethics are intended to remove any fear of misinterpreted intent by drawing a clear definition between palliative care and euthanasia, center director Peter Singer says.
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He wants the 16 guidelines to be adopted by professional organizations, critical care societies, regulatory authorities and medical examiners as a uniform system for intensive care doctors who deal with the dying.
While pain management guidelines exist in U.S. hospitals, the study by the Toronto center is considered a first step toward addressing the issue of dying patients in intensive care units.
Making distinctions between care for the dying and assisting in death -- euthanasia -- is most difficult in treatment given in intensive care units where rapid decisions have to be made, Singer said.
The guidelines would provide clarity and protection for doctors trying to stop the pain of dying patients, even if that means prescribing such high levels of medication that it hastens death, according to Singer.
"If the amount of narcotics/sedatives required to relieve pain and suffering at the end of life may foreseeably cause hastening of death, although the physician's intent is solely to relieve suffering, this should be considered palliative care," reads one guideline involving what doctors refer to as the "double effect" of high doses of painkillers.
Singer said showing the doctor's intent was to alleviate pain and suffering was crucial to the guidelines, which call for physicians to document all information concerning prescribed painkillers to demonstrate they were responding to the patient's needs.
The guidelines say "terminal sedation," in which a dying patient is sedated intravenously until becoming unconscious until death ensues from the underlying illness, also is palliative care and not euthanasia.
Such a practice could make detecting assisted suicide more difficult, the report said, adding: "Once again, the intent of the physician is crucial."
The guidelines also oppose setting any figure for maximum dosage, to prevent a threshold that doctors could cross in trying to assist patients in severe pain.
"All we're saying is that this fear that someone is crossing the line and getting into euthanasia is really detracting from a far more important issue, which is that people shouldn't die in pain," Singer said.
Kathleen Foley of Memorial Sloan-Kettering Cancer Center in New York, director of the Project on Death in America for the Open Society Institute, welcomed the proposed guidelines for adding to the discussion of a topical issue.
"It's important to have national guidelines to provide transparency on the intent of the physician," Foley said. "Everyone is trying to improve the quality of the life of patients before they die."
Documenting all the decisions for prescribing medication protected "the moral integrity" of everyone in an intensive care unit by showing the desire was "not to kill the patient, but provide comfort," she said.
Laura Hawryluck of the University of Toronto, who led the study that compiled the guidelines, said the goal was to allow doctors to treat each patient as an individual without fear of getting in trouble for trying to eliminate pain and suffering.
"In caring for dying people, we don't always document why we're going up on a drug," said Hawryluck, an intensive care physician. "It may be clear to us. It may not be clear to other people."
Dying without pain or debilitating symptoms of illness such as breathing problems is a major component of quality end-of-life care, Singer said. Patients also want a say in whether to be helped by life-sustaining treatment, and seek a culturally sensitive environment where they can be with their loved ones, he said.
"If you're in pain, you're not going to feel very comfortable about making decisions on life-sustaining equipment or saying goodbye to your children," Singer said.
http://www.nj.com/news/ledger/index...67414124933.xml
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God bless,
Kindgo
Inside the will of God there is no failure. Outside the will of God there is no success.
Posts: 4320 | From: Sunny Florida | Registered: Jun 2002
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