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Ethical Decision-making
Published in Margaret O’Connor, Sanchia Aranda, Susie Wilkinson, Palliative Care Nursing, 2018
Margaret O’Connor, Sanchia Aranda
Sedation is certainly used at the end of life for a small number of people with intractable symptoms and for whom no other relief of suffering is available. In some situations, it is not possible to control refractory symptoms—that is, symptoms that cannot ‘adequately be controlled despite aggressive efforts to identify a tolerable therapy that [does] not compromise consciousness‘ (Cherney & Portenoy 1998). In the face of such refractory symptoms, a negotiated and stepped approach is undertaken using moderate doses of tranquillising medication to assist in stabilisation. In such cases, sedation is used as a last resort. The term ‘pharmacological oblivion’ is sometimes used to describe such sedation, but the term is often used pejoratively, implying ‘deep sleep therapy’ or coma (Syme 1999). Cherney and Portenoy (1998) have argued that the use of sedation for intractable symptoms is undertaken on the same basis as any other clinical practice—whereby the goal is relief of suffering, rather than the death of the person. Sedation can be offered on a trial basis to people with intractable symptoms who have exhausted all other options. After several hours the person’s sedation is lightened to allow a discussion on the effectiveness of the treatment and an informed decision on whether to continue for a further trial period. Clinical pragmatism can thus be used to make difficult clinical decisions in the context of unrelieved suffering.
An Overview of Position Documents
Published in Dale A. Stirling, Biomedical Organizations, 2012
<http://www.ranzcp.org> Position StatementsAbolition of TortureAlcohol Misuse and DependenceContinuing Medical Education Within the CollegeDeep Sleep TherapyFirearm Legislation in AustraliaHIV/AIDSMethadone Prescription by PsychiatristsOrthomolecular PsychiatryPathological/Problem GamblingPolicy on Mental Health ServicesPosition Statement on PsychosurgeryPrinciples on the Provision of Mental Health Services to Asylum SeekersPsychiatry Services for the ElderlyRecent Changes to Australian National Mental Health PolicyRelationships Between Geriatric and Psychogeriatric ServicesThe Role of Psychiatrists in DisastersThe Safe Use of ClozapineSt. John’s WortStolen GenerationsTelepsychiatryTranscranial Magnetic StimulationWhat Is a Psychiatrist? What Does a Psychiatrist Do?
The Ethical Integrity of the Power Differential in Mental Health Nursing
Published in Issues in Mental Health Nursing, 2023
The power differential is embedded in mental health nursing and introduces substantial ethical complexity. The dual potential of the power differential for healing or harm challenges the assertion that the power differential is invariably detrimental (Chamberlin, 2005). It is then necessary to establish fiduciaries that maintain therapeutic alignment of the power differential. To this end, practice must be delivered with rigorous consideration for evidence. Transorbital lobotomy, deep sleep therapy and conversion therapies were developed and practiced in the absence of disinterested scrutiny or sufficiently credible evidence (Caruso & Sheehan, 2017; Cramer et al., 2008; Walton, 2013). Whilst a high standard of evidence for biomedical therapies is an ethical imperative (World Medical Association, 2018), evidence used to guide practice must be focussed on and co-created with the people upon whom the power differential is most consequential. That is, consumers themselves must be involved in the development, delivery and appraisal of mental healthcare.