Doctrine of Double Effect: Nursing Care

The paper “The Doctrine of Double Effect: Nursing Care” is an excellent example of a case study on nursing. This study proposes to enquire into one aspect of nursing care in which the Doctrine of Double Effect can be applied. Palliative care in which patients need to be put on sedation evokes DDE involving ethical questions. Whether by applying the DDE, the sedation can be justified under the nursing perspective will be the main object of this study.Doctrine of Double Effect: Nursing Care

This doctrine of double effect originated from Roman Catholic theology which advocated its use when the harmful results of action become unavoidable. It gives the practitioner the choice to select the lesser evil. (HPNA 2003) Four ingredients should be present in the said doctrine. An action is permissible even if it has one good and one bad effect provided that 1) Action is not immoral, 2) It is reported to achieve good effect without the intention of any bad effect though it may be anticipated, 3) Good effect is not achieved through bad effect, and 4) the action is resorted to under extreme crisis situation. (Sulmasy and Pellegrino 1999)

Palliative care

Palliative care is one area where the nursing profession faces ethical questions. Apart from the principles of beneficence, maleficence, the doctrine of double effect gives the nursing profession justification for the desired action. Palliative care warranting sedation is an alternative to euthanasia. The intent behind palliative care is to minimize distress and euthanasia is to let the patient die. The doctrine of double effect motivates the professional to resort to palliative sedation as an alternative to let the patient suffer from pain, though euthanasia will give the same result it is against ethical principles as an extreme and easy but cruel alternative. An unintended effect of an intervention is far superior to the intended effect of an intervention. Hence, intentionally causing death by euthanasia is abhorred and non-violent means of embracing death without pain through a high dose of tranquilizers and opioids is advocated Doctrine of Double Effect: Nursing Care

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A case of the terminally ill 78-year old man is presented here to explain the application of the doctrine. He had advanced prostate cancer spread to his bones and bone marrow. His platelets count in blood was threatening to cause severe internal bleeding. The Diclofenac treatment for his bony pain was contraindicated as the drug would cause further worsening of platelets condition and the bleeding would increase which was a life-threatening condition. Therefore Diclofenac was stopped to reduce bleeding. But due to the stoppage, his pain increased. The question was whether Diclofenac should be restarted. Applying the principle of double effect, it can be said that Diclofenac can be restarted so that the patient’s severe pain can be mitigated even though its potential to cause bleeding is foreseen. The good effect of reducing the pain outweighs the risk of death due to the side effects of bleeding.Doctrine of Double Effect: Nursing Care Earlier, due to an increase in pain at the back, he was put on the catheter which later infected the site. Now unless the catheter was removed, infection would proliferate and hasten his death. The dilemma now calling for the application of the double effect doctrine was whether the catheter should be removed as otherwise, he would develop meningitis. By applying the doctrine, it was decided not to remove the catheter because if the catheter was removed, he would die of pain and if not removed; he would be free from pain though in both cases death was a known possibility. Actually the patient died within 48 hours peacefully with no evidence of meningitis. On reflection, in the first situation, the patient was fully conscious and he was part of the decision making to continue on Diclofenac. In the second situation of having to remove the catheter, he was not competent enough to decide and the medical staff decided in the best interests of the patient. This doctrine can be abused and it is also prone to criticism. The honest intent cannot, however, be proved (Kendall, C.E 2000)Doctrine of Double Effect: Nursing Care