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Module 3: Analyzing Ethical Challenges in Pediatric
End-of-life Decision Making

Ethical Issues in the Treatment of Pain and Suffering
at the End of Life


 Facilitators Guide Download PDF  PowerPoint Download PowerPoint

This seminar addresses three challenging issues that arise in making treatment decisions at the end of a child's life.

  • Titrated analgesia for the relief of refractory pain: Where is the line between comfort care and euthanasia?
  • Sedation for Intractable Distress in the Dying (SIDD): Is putting a patient in a state of unconsciousness the same thing as euthanasia?
  • Neuromuscular blocking agents: Is withdrawing treatment from a paralyzed patient always euthanasia?

Through case examples, participants discuss the key ethical and legal principles surrounding these questions, and the conditions under which each of the actions is and is not permissible.

Learning Objectives

As a result of attending this session, participants will be able to:

  • Explain the doctrine of double effect (DDE) and its use as ethical and legal justification for the use of titrated opioid medications to relieve refractory symptoms near the end of life, even in cases where these medications may hasten death.
  • Recognize that the doctrine of double effect also provides ethical and legal justification for sedation in cases where no other options will relieve severe pain and suffering near the end of life, even if sedation is likely to hasten death.
  • State the criteria that must be met in order for the doctrine of double effect to be applied to cases where proposed treatments have some risk of hastening death.
  • Recognize that it is not ethically or legally permissible to initiate neuromuscular blocking agents after a decision has been made to withdraw a patient from mechanical ventilation.
  • Recognize situations in which it may be permissible to withdraw mechanical ventilation from a paralyzed patient and provide a justification for doing so.

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