Charles Douglas

Publications (3)6.18 Total impact

• Article: The Devil is in the detail: best practice, or Catholic practice?

  Charles Douglas, Melanie Jansen, Ian Kerridge
  The American journal of bioethics: AJOB 07/2012; 12(7):38-9. · 4.00 Impact Factor
• Article: Decision aids for breast and nodal surgery in patients with early breast cancer: development and a pilot study.

  Rachael Harwood, Charles Douglas, David Clark
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  ABSTRACT: As survival rates for aggressive and conservative breast and lymph node surgery are similar, surgical treatment decisions for patients with early-stage breast cancer should take patient preference into account. Decision aids have been demonstrated to increase patient knowledge and satisfaction with decision making, while decreasing decisional conflict. Hundreds of decision aids exist; however, few address lymph node surgery in any detail, and none acknowledge that there is a choice comparable to that between mastectomy and breast-conserving therapy. A systematic process was employed to develop decision aids for mastectomy versus breast-conserving therapy, axillary dissection versus sentinel node biopsy, and options following a positive sentinel node biopsy. The first two of these decision aids were evaluated in a small pilot study. Choice of operation, knowledge and decisional conflict and satisfaction were compared with outcomes in an historical control group. Women reported favorably on the decision aids. The numbers in the pilot group were too small to allow definitive conclusions to be drawn, but suggested a possible reduction in decisional conflict, and possibly increase in decisional satisfaction, knowledge and choice of axillary clearance (rather than sentinel node biopsy) in the intervention group. These decision aids could improve decision making for the surgical treatment of early breast cancer. A prospective randomized, control trial is needed to further evaluate the impact of these decision aids, particularly in the case of nodal surgery.
  Asia-Pacific Journal of Clinical Oncology 06/2011; 7(2):114-22. · 0.58 Impact Factor
• Article: Managing intentions: the end-of-life administration of analgesics and sedatives, and the possibility of slow euthanasia.

  Charles Douglas, Ian Kerridge, Rachel Ankeny
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  ABSTRACT: There has been much debate regarding the 'double-effect' of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing 'slow euthanasia.' On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten death. In this paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary 'slow euthanasia'). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a 'grey' area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that 'slow euthanasia' may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of 'time' for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed.
  Bioethics 07/2008; 22(7):388-96. · 1.60 Impact Factor