Problem
Clinical Scenario on Double Effect
Ms SK was a 77-year-old woman followed by oncology for her widely metastatic lung cancer. Her disease was re- fractory to treatment and progressed; she grew weaker. She chose comfort-focused care and refused further cyto- toxic therapy. Extensive osseous involvement began to cause her excruciating bone pain at multiple sites, and the pain progressed despite several courses of palliative radiation therapy, bisphosphonates, and increasing doses of opioids and coanalgesic medications. She was dyspneic and anxious, with both symptoms aggravated by her severe pain. She was admitted to a local hospital for general decline, dehy- dration, and severe pain. Increasing doses of intermittent intravenous morphine were administered with suboptimal effect, and 2 days after admission, a continuous morphine infusion with prn clinician-administered boluses was or- dered. After aggressive dose titration, at last, the patient seemed to achieve an acceptable level of comfort and calm. She remained intermittently awake and interacted with family at her bedside, but some of the staff was un- comfortable administering increasingly high doses of opioid, fearing that they would hasten the patient"s death.
Are these nurses ethically justified in giving very high doses of opioids for pain at the end of life
To make such a determination, one must analyze an action onthe basis of four conditions; all of which mut be met for the action to be morally justifiable. The conditions of the principle of double effect are the following
1) The act-in-itself cannot be morally wrong or intrinsically evil
2) The bad effect cannot cause the good effect. The agent cannot intend the bad effect.
3) The bad effect cannot outweigh the good effect; there is a proportionate reason to tolerate the bad effect.
• Explain your stand using the 4 basic conditions.