Morphine vs. ABT-594: A Reexamination by the Principle of Double Effect
Not long ago, at the request of the nursing staff at a local Catholic hospital, I was consulted as a bioethicist regarding the case of an 86-year-old woman who had metastatic colon cancer and Alzheimer's disease. The non-competent patient was in the last stages of terminal cancer and her attending physician, with the consent of her surrogate decision-maker, decided that all aggressive medical treatment should be tenninated and palliative care should be initiated. The only request by the family was that their mother be free of pain. Unsure of the extent of the patient's pain due to the Alzheimer's disease the physician started a morphine drip. The purpose of the morphine was to manage the patient's pain, but everyone knew that the continuous injection of morphine into the patient's vein would gradually kill the patient by depressing her respiration. The nursing staff was very uncomfortable with this because they questioned whether the physician and family were directly trying to shorten the patient's life. The patient did not appear to be in serious pain and without the morphine she would probably live for days or even weeks. Two ethical questions arose: first, was the morphine necessary in this case; and second, was the morphine being used for pain management or was it being used as a form of assisted suicide? It is estimated that 30 to 40 million Americans depend on morphine, despite its side effects, to relieve severe pain. The use of morphine as a pain reliever, even at high doses, has been accepted by the Roman Catholic Church for centuries under the principle of double effect. The Church argues that there is a moral difference between the effects of actions which