Bioethics. 2020 Nov;34(9):977-983. doi: 10.1111/bioe.12792. Epub 2020 Jul 14.
Continuous deep sedation (CDS) has the effect of making the patient unconscious until death, and that it has this effect is clearly an undesirable aspect of CDS. However, some authors have recently maintained that many physicians do not intend this effect when practicing CDS. According to these authors, CDS is differentiated into two types; in what is called "gradual" CDS (or CDS as a result of proportionate palliative sedation), physicians start with low doses of sedatives and increase them only gradually, whereas in "rapid" CDS (or palliative sedation to unconsciousness), physicians rapidly administer a heavy dose that clearly induces unconsciousness from the beginning. The claim is that the physicians intend permanent unconsciousness only if they rapidly administer a heavy dose, but they do not intend it when the unconsciousness is the result of a gradual increase of sedatives. This paper attempts to refute these claims based on a close examination of the protocol of gradual CDS. If my argument is valid, the doctrine of double effect would not be useful in justifying most, if not all, cases of CDS.
持续深度镇静（CDS）会使患者无意识直至死亡，而这种效果显然是 CDS 的一个不理想方面。然而，最近一些作者认为，许多医生在实施 CDS 时并非有意产生这种效果。根据这些作者的说法，CDS 分为两种类型；在所谓的“逐渐”CDS（或比例性缓和镇静导致的 CDS）中，医生从低剂量镇静剂开始，并逐渐增加剂量，而在“快速”CDS（或迅速给予大剂量镇静以达到无意识状态）中，医生会迅速给予大剂量镇静剂，从一开始就明显导致无意识状态。据称，只有当医生快速给予大剂量镇静剂时，才会有意使患者永久无意识，但如果无意识是镇静剂逐渐增加的结果，则并非如此。本文试图基于对逐渐 CDS 方案的仔细检查来反驳这些说法。如果我的论点有效，那么双重效应学说在为大多数（如果不是全部）CDS 案例辩护时就没有用处。
