{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:35:02Z","timestamp":1782322502969,"version":"3.54.5"},"reference-count":34,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2012,6,1]],"date-time":"2012-06-01T00:00:00Z","timestamp":1338508800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2012,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A variety of moral frameworks can assist clinicians in making ethical decisions. In examining articles on palliative sedation and terminal extubation, we were struck that bioethical discussions uniformly appealed to principlism and especially to the rule of double effect. Other moral frameworks were rarely invoked, an observation consistent with Daniel Callahan's assertion that principlism has a \u201cblocking effect\u201d on broader ethical deliberation. We review here the principle of double effect as it applies to clinical acts that may hasten death, and present one radically different ethical formulation developed by Dan Brock. We then offer brief examples of how clinicians might use other moral frameworks to assess the ethics of preemptive sedation for terminal extubation. We argue for greater moral pluralism in approaching end-of-life decisions.<\/jats:p>","DOI":"10.1089\/jpm.2011.0157","type":"journal-article","created":{"date-parts":[[2012,4,30]],"date-time":"2012-04-30T14:53:09Z","timestamp":1335797589000},"page":"709-713","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Monolithic Moral Frameworks: How Are the Ethics of Palliative Sedation Discussed in the Clinical Literature?"],"prefix":"10.1177","volume":"15","author":[{"given":"J. Andrew","family":"Billings","sequence":"first","affiliation":[{"name":"Cambridge Health Alliance, Cambridge, Massachusetts, and Massachusetts General Hospital and the Harvard Medical School Center for Palliative Care"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry R.","family":"Churchill","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2012,6,1]]},"reference":[{"key":"e_1_3_3_2_2","first-page":"169","volume-title":"Social Medicine Reader: Patients, Doctors, and Illness","author":"Churchill LR","year":"2005","unstructured":"Churchill LR, , King NMP, , Schenck D. Ethics in medicine: an introduction to moral tools and traditions. King NMP, , Straus RP, , Churchill LR, , Estroff SE. Social Medicine Reader: Patients, Doctors, and Illness, 2nd. 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