Mayo Clinic review of ethical decision making with end-of-life care

October 01, 2010

ROCHESTER, Minn. -- In a review article published in the October issue of Mayo Clinic Proceedings,(http://www.mayoclinicproceedings.com) Mayo Clinic physicians differentiate the ethical and legal permissibility of withholding or withdrawing life-sustaining treatments and accepted comfort measures, specifically palliative sedation, from that of physician-assisted suicide or euthanasia.

Physician reviewers find that palliative sedation has an important place on the continuum of appropriate palliative care. "At the end of life, patient goals often shift to comfort, and removal of burdens and relief of suffering become paramount," says lead author, Paul Mueller, M.D.(http://www.mayoclinic.org/bio/10560459.html), General Internal Medicine (http://www.mayoclinic.org/general-internal-medicine-rst/), Mayo Clinic. "Many physicians are uncomfortable removing life-sustaining therapy or providing comfort-directed medication because of confusion about the ethical soundness of such treatments. In contrast to physician-assisted suicide or euthanasia, withdrawal of or withholding life-sustaining treatment and administering palliative sedation are ethically sound options."

Palliative sedation is appropriate therapy for refractory and unacceptably severe suffering. "As with any other therapy, the patient or surrogate should be informed of potential adverse effects, including loss of social interaction and potential for life-threatening aspiration or respiratory depression. Palliative medicine teams should be involved, if possible, in any case in which palliative sedation is considered," says Dr. Mueller.

"We hope that by increasing familiarity with the ethical basis for these practices we will encourage their appropriate application," he adds.
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A peer-reviewed journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at www.mayoclinicproceedings.com.

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For more than 100 years, millions of people from all walks of life have found answers at Mayo Clinic. These patients tell us they leave Mayo Clinic with peace of mind knowing they received care from the world's leading experts. Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. At Mayo Clinic, a team of specialists is assembled to take the time to listen, understand and care for patients' health issues and concerns. These teams draw from more than 3,700 physicians and scientists and 50,100 allied staff that work at Mayo Clinic's campuses in Minnesota, Florida, and Arizona; and community-based providers in more than 70 locations in southern Minnesota, western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To best serve patients, Mayo Clinic works with many insurance companies, does not require a physician referral in most cases and is an in-network provider for millions of people. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education, visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your general health information.

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