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John M. Luce, MD
University of California, San Francisco

JAMA. 1992;268(14):1858.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—We appreciate the response of Drs Hooyman and Veremakis to our recent study. We agree with their first reservation regarding the use of deeply comatose patients who did not receive drugs as a control group compared with patients who are not deeply comatose and did receive drugs, and we expressed this reservation in our article.¹ However, as Hooyman and Veremakis note, a better control group was not available to us and is unlikely to be available to other investigators in the future.

As for their second reservation regarding the principle of double effect, we note that the source we cited on this principle emphasized the importance of the primary motivation, relief of pain and suffering, in ordering and administering sedatives and analgesics. Because such relief was the primary motivation for the physicians and nurses in our study, we stated that their actions were ethically justified. Hooyman and Veremakis . . . [Full Text PDF of this Article]

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