AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2003, Volume 5, Number 1.


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Glossary: End-of-Life Care: Do No Harm

Cross tolerance – the resistance to one or several effects of a compound as a result of tolerance developed to a pharmacologically similar compound. (See "tolerance.")

Euthanasia – the administration of a lethal agent by another person to a patient for the purpose of relieving the patient's intolerable and incurable suffering (AMA Code of Medical Ethics, Opinion 2.21). Defined thus, euthanasia can occur with or without the patient's knowledge and consent. Where euthanasia is legally permitted, notably in the Netherlands, regulations specify that it only be undertaken with the patient's written informed consent and under strict guidelines.

Euthanasia differs from physician-assisted suicide in which a physician provides information about or prescription for a lethal agent but does not administer the agent. (See "physician-assisted suicide.")

Euthanasia also differs from the withholding and withdrawing life-sustaining treatment. In euthanasia, an agent is administered that causes the patient's death. When life-sustaining treatment is withheld or withdrawn, the patient's underlying disease is the cause of death. (See "withholding and withdrawing life-sustaining treatment.")

Physician-assisted suicide – occurs when a physician facilitates a patient's death by providing the necessary means or information to enable the patient to perform the life-ending act (AMA Code of Medical Ethics, Opinion 2.211).

Principle of double effect –taken from Catholic doctrine that permitted certain acts of abortion when mothers' lives were in danger, this principle distinguishes between the intention with which an action is performed and the consequence it produces. Under the principle of double effect, if drugs are administered with the intent of relieving pain and death occurs as an unintended consequence, the action is not considered to be euthanasia. Even though the result may be expected, as long as the intent was not to hasten death or kill the patient, the action is not prohibited by general bioethics principles. The AMA Code of Medical Ethics is silent on the principle of double effect.

Terminal sedation – terminal sedation is the use of high doses of sedatives to relieve extremes of physical distress. Its purpose is to render the patient unconscious to relieve suffering until the patient dies from his or her disease processes and their complications. The AMA Code of Medical Ethics is silent on the topic of terminal sedation.

Tolerance – resistance to the effects of a pharmacological agent as a result of sustained or large-dose exposure to the agent.

Withholding and withdrawing life-sustaining treatment – life-sustaining treatment includes, but is not limited to, mechanical ventilation, renal dialysis, chemotherapy, and administration of artificial nutrition and hydration. The AMA Code of Medical Ethics, and the majority bioethics opinion accept that " a competent, adult patient, may, in advance, formulate and provide a valid consent to the withholding and withdrawing of life-support systems in the event that injury or illness renders that individual incompetent to make such a decision" (AMA Code of Medical Ethics, Opinion 2.20). A designated patient surrogate may also make the decision to withhold or withdraw such treatment. The Code recognizes no ethical difference between the withholding and the withdrawal of life-sustaining treatment.

Withholding and withdrawing life-sustaining treatment is distinguished from euthanasia (see "euthanasia) and physician-assisted suicide (see "physician-assisted suicide.")

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