![]() ![]() To date there has not been a court case in Australia which has specifically confirmed that double effect is part of Australian law (though the Family Court in Re Baby D (No 2) suggests it likely is). The doctrine of double effect originated from moral theology. In South Australia, it will apply only when the person is in the terminal phase of a terminal illness. The requirement for a person to be near death is discussed further below. The better the person’s prognosis, the less likely the doctrine will protect health professionals if death is hastened. The law is unlikely to protect the provision of pain and symptom relief when the person's death is not imminent. This is specifically required by the legislation in some States and Territories.ĭouble effect is likely to apply only when the person is near death. ![]() nurses, carers and family members will also be protected provided a doctor has authorised them to administer it, and supervises the medication plan. Other people who deliver pain and symptom relief e.g. If the primary intention is to relieve pain and symptoms, not cause death, the person who gave the medication will not be criminally responsible for a death which follows, even if it is foreseen.Īdministered by a doctor, or someone authorised by a doctorĭoctors are protected by double effect. The most critical element of double effect is intention. medication is prescribed and administered by a doctor caring for the person, or administered under that doctor's orders and.the primary intention is to relieve pain and symptoms, not hasten death.While the scope of the law in Australia has not yet been tested, double effect is likely to apply only when: This recognises that giving medication (usually by a health professional) to a person to relieve pain and symptoms is lawful even if it could hasten death. In this situation the ‘doctrine of double effect’ may apply. Awareness of the dosage factors will improve our ability to treat and predict probable HDM dosage, thus shortening the period until pain relief is reached.In the final stages of life, there may be concerns that pain and symptom relief may have the unintended effect of hastening a person's death. High morphine dosage does not affect patient survival. No significant dose-limiting adverse effects were observed, suggesting a high clinical safety profile. The median survival of patients on HDM was 15.6 days and did not differ from the survival of patients taking a lower dosage.Ī fairly strong correlation exists between morphine dosage and some clinicodemographic data. Statistical analysis indicated a positive correlation between the log maximum of morphine dosage and the total number of rescue dosages (r = 0.307, P = 0.025). Primary breast and genitourinary cancers, as well as metastases to bone and spinal diseases, were associated with higher morphine dosages. Male patients and nonwhite patients required slightly higher dosages than others. Morphine dosage was negatively associated with age (r = -0.35, P = 0.01). The authors identified 453 patients (69.58%) who received morphine for pain relief, of whom 55 (12.14%) needed more than 299 mg/day. Information was collected regarding demographic parameters, medical diagnosis, pain mechanism, morphine dosage, use of rescue doses in addition to regular doses, use of coanalgesics and adjuvant treatments, and survival time in the hospice setting as associated with morphine dosage. The authors retrospectively studied the medical records of all 651 inpatients hospitalized at their center between January 1996 and December 1997. ![]() However, it is unknown how many of the patients require high dose morphine (HDM, >299 mg/day of oral morphine equivalent), what the characteristics of these patients are, and whether the use of HDM might affect their survival. Pain control is one of the most important goals of end-of-life care, and the use of opioids for this purpose is extremely common in hospice settings. ![]()
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