Avanços em Ética Médica

Avanços em Ética Médica
Acesso livre

ISSN: 2385-5495


Proportionality in determining intention

Shin W. Sim, Lalit K. Radha Krishna

Background: This article aims to explore the idea of proportionality within the context of the application of continuous deep sedation in end-of-life care, and to evaluate its importance in discerning intention. Methods: Two case studies are used to explore the concept of proportionality and the ‘Doctrine of the Double Effect’. The first highlights the importance of a holistic appreciation of a patient’s clinical, social, emotional, psychological, spiritual and cultural contexts. The second case study evaluates the appropriateness of a proportional response to continuous deep sedation. Results: The case studies show that the responses made by a patient’s multidisciplinary care teams ought to ‘fit’ the situation. This highlights the need for proportionate, appropriate measures that are in keeping with the wishes and goals of the patient, and suggests a need to consider individuals’ narratives and a holistic appreciation of their situations. Conclusions: Application of the Theory or Principle of Proportionality is imperative to expound the intentions of the physician, and the multidisciplinary care team as a whole. The idea of proportionality encapsulates the idea of appropriate use and, in keeping with the patient’s wishes, echoes the central ethos of a palliative care approach.