In 5 documents the rationale behind the refusal of interventions that deliberately hasten death is that dying has to be considered as a normal part of the life process. There is a nuanced difference between the documents stating that palliative care should not accelerate nor delay death (e.g. WHO I, EAPC I, UK SC), and documents affirming that palliative care does not intend Inhibitors,research,lifescience,medical to accelerate nor postpone death (e.g. USA HPNA I, USA ONS I). Interestingly, one document contends that the naturalness of death is compatible with declining or withdrawing futile treatments (i.e. AUSTRALIA PCA II). Two of
the Inhibitors,research,lifescience,medical documents refer to the rule of “double effect” to justify the use of pain medication which might have a secondary and unintended Belinostat supplier effect of hastening death (i.e. CANADA CNA, USA HPNA I). E2 – Death as an unwanted effect of sedation/Withdrawing
or withholding treatments/Euthanasia and assisted suicide Euthanasia and assisted suicide are considered unethical, but terminal pharmacological deep sedation Inhibitors,research,lifescience,medical and the (even if rare) life shortening due to effective/high doses of analgesics and/or sedatives are not to be considered as euthanasia (e.g. USA AAHPM V, USA HPNA I). In general, the withdrawing or the withholding of treatments are considered as acceptable measures only if treatments do not effect any amelioration of the
patient’s condition, but merely prolong the process of Inhibitors,research,lifescience,medical dying (e.g. WHO I, EAPC II, USA AMA). One of the documents (e.g. USA ACS) highlights the doctor’s responsibility of sparing futile treatments in every situation that involves imminent dying. Nevertheless, several documents clearly state Inhibitors,research,lifescience,medical that withdrawing and withholding treatments (including life-sustaining measures) should be consistent with the patient’s wishes (e.g. WMA III, CANADA CHPCA II, USA AAHPM II). Amongst these documents, one clearly states AV-951 that artificial nutrition and hydration should be considered as any other treatments and might be withhold or withdrawn when doing so is consistent with the patient’s preferences (i.e. USA NHPCO IV). E3 – Participation in the decision-making process All documents maintain that patients should be selleck bio involved in every decision concerning treatments. Up to 12 documents by international and national organizations (e.g. WMA I, USA HPNA I, USA NHPCO IV, CANADA CHPCA I, AUSTRALIA AMA) clearly state that patients have a “right” to make informed decisions on treatments, including the right to refuse treatments. Five of the documents (i.e.