Table 1

Initial Delphi Questionnaire ---- Intensivists


How should patients' pain and suffering be controlled at the end-of-life? (which drugs?, when?, how much?) Please justify your answer.a


What indications of the patient experiencing suffering and/or pain should be used to judge whether an appropriate amount of narcotic or sedative has been used?


Is there a maximal dose of narcotic or sedative that you would recommend not be exceeded? Please justify your answer.


During withdrawal of care, would you recommend that narcotics and/or sedatives be given in incremental doses once suffering is evident or before it begins?


Is euthanasia (as defined in background information) acceptable or unacceptable?


a) Is terminal sedation (sedation to relieve pain until death occurs from the disease itself) euthanasia or acceptable practice? b) In terminal sedation, how should the drugs used to induce unconsciousness be incremented to palliate without causing death?


How can the intentions of the physicians administering sedatives/narcotics at the end-of-life be assessed (e.g. to palliate vs. to euthanize or to assist suicide)?


If the amount of narcotics and/or sedatives required to relieve pain and suffering at the end-of-life may forseeably cause hastening of death although the physician intends only to relieve pain and suffering, should this be considered assisted suicide or euthanasia?


How can palliative care be distinguished from euthanasia/assisted suicide in the ICU setting?

a This question was omitted from the coroners' initial questionnaire.

Hawryluck et al. BMC Medical Ethics 2002 3:3   doi:10.1186/1472-6939-3-3

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