Death, Devices, and Double Effect

Overview

Journal HEC Forum

Specialties Forensic Sciences
Health Services
Medical Ethics

Date 2018 Sep 3

PMID 30173400

Authors

Stuart G Finder

Michael Nurok

Affiliations

Soon will be listed here.

Abstract

Along with the growing utilization of the total artificial heart (TAH) comes a new set of ethical issues that have, surprisingly, received little attention in the literature: (1) How does one apply the criteria of irreversible cessation of circulatory function (a core concept in the Uniformed Determination of Death Act) given that a TAH rarely stops functioning on its own? (2) Can one appeal to the doctrine of double effect as an ethical rationale for turning off a TAH given that this action directly results in death? And, (3) On what ethical grounds can a physician turn off a TAH in view of the fact that either the intent of such an action or the outcome is always, and necessarily, death? The aim of this article is not to answer these questions but to highlight why these questions must be explored in some depth given the growing use of TAH technology.

References

DuBois J . Non-heart-beating organ donation: a defense of the required determination of death. J Law Med Ethics. 2001; 27(2):126-36. DOI: 10.1111/j.1748-720x.1999.tb01445.x. View

Bica C . Another perspective on the doctrine of double effect. Public Aff Q. 2001; 13(2):131-9. View

Sprung C, Cohen S, Sjokvist P, Baras M, Bulow H, Hovilehto S . End-of-life practices in European intensive care units: the Ethicus Study. JAMA. 2003; 290(6):790-7. DOI: 10.1001/jama.290.6.790. View

Giannini A, Pessina A, Tacchi E . End-of-life decisions in intensive care units: attitudes of physicians in an Italian urban setting. Intensive Care Med. 2003; 29(11):1902-10. DOI: 10.1007/s00134-003-1919-4. View

McIntyre A . The double life of double effect. Theor Med Bioeth. 2004; 25(1):61-74. DOI: 10.1023/b:meta.0000025095.73394.34. View

Jansen L . Hastening death and the boundaries of the self. Bioethics. 2006; 20(2):105-11. DOI: 10.1111/j.1467-8519.2006.00481.x. View

Marquis D . Four versions of double effect. J Med Philos. 1991; 16(5):515-44; discussion 565-70. DOI: 10.1093/jmp/16.5.515. View

Sulmasy D . Within you/without you: biotechnology, ontology, and ethics. J Gen Intern Med. 2008; 23 Suppl 1:69-72. PMC: 2150626. DOI: 10.1007/s11606-007-0326-x. View

Miller F, Truog R, Brock D . Moral fictions and medical ethics. Bioethics. 2009; 24(9):453-60. DOI: 10.1111/j.1467-8519.2009.01738.x. View

10.

Allmark P, Cobb M, Liddle B, Tod A . Is the doctrine of double effect irrelevant in end-of-life decision making?. Nurs Philos. 2010; 11(3):170-7. DOI: 10.1111/j.1466-769X.2009.00430.x. View

11.

Gilder S . Twenty-second World Medical Assembly. Br Med J. 2010; 3(5616):493-4. PMC: 1986380. DOI: 10.1136/bmj.3.5616.493. View

12.

Truog R, Brock D, White D . Should patients receive general anesthesia prior to extubation at the end of life?. Crit Care Med. 2012; 40(2):631-3. DOI: 10.1097/CCM.0b013e3182413b8a. View

13.

Trankle S . Decisions that hasten death: double effect and the experiences of physicians in Australia. BMC Med Ethics. 2014; 15:26. PMC: 3994289. DOI: 10.1186/1472-6939-15-26. View

14.

Pilkington B . On omissions and artificial hydration and nutrition. J Med Philos. 2014; 39(4):430-43. DOI: 10.1093/jmp/jhu022. View

15.

Stolz E, Grossschadl F, Mayerl H, Rasky E, Freidl W . Determinants of acceptance of end-of-life interventions: a comparison between withdrawing life-prolonging treatment and euthanasia in Austria. BMC Med Ethics. 2015; 16(1):81. PMC: 4666202. DOI: 10.1186/s12910-015-0076-y. View

16.

Misak C, White D, Truog R . Medically Inappropriate or Futile Treatment: Deliberation and Justification. J Med Philos. 2015; 41(1):90-114. PMC: 4882630. DOI: 10.1093/jmp/jhv035. View

17.

Chung G, Yoon J, Rasinski K, Curlin F . US Physicians' Opinions about Distinctions between Withdrawing and Withholding Life-Sustaining Treatment. J Relig Health. 2016; 55(5):1596-606. DOI: 10.1007/s10943-015-0171-x. View

18.

Cook J, Shah K, Quader M, Cooke R, Kasirajan V, Rao K . The total artificial heart. J Thorac Dis. 2016; 7(12):2172-80. PMC: 4703693. DOI: 10.3978/j.issn.2072-1439.2015.10.70. View

19.

Kon A, Shepard E, Sederstrom N, Swoboda S, Marshall M, Birriel B . Defining Futile and Potentially Inappropriate Interventions: A Policy Statement From the Society of Critical Care Medicine Ethics Committee. Crit Care Med. 2016; 44(9):1769-74. DOI: 10.1097/CCM.0000000000001965. View

20.

Devettere R . Reconceptualizing the euthanasia debate. Law Med Health Care. 1989; 17(2):145-55. DOI: 10.1111/j.1748-720x.1989.tb01086.x. View