The double life of double effect

The U.S. Supreme Court's majority opinion in Vacco v. Quill assumes that the principle of double effect explains the permissibility of hastening death in the context of ordinary palliative care and in extraordinary cases in which painkilling drugs have failed to relieve especially intractable suffering and terminal sedation has been adopted as a last resort. The traditional doctrine of double effect, understood as providing a prohibition on instrumental harming as opposed to incidental harming or harming as a side effect, must be distinguished from other ways in which the claim that a result is not intended might be offered as part of a justification for it. Although double effect might appropriately be invoked as a constraint on ordinary palliative care, it is not clear that it can be coherently extended to justify such practices as terminal sedation. A better approach would reconsider double effect's traditional prohibition on hastening death as a means to relieve suffering in the context of acute palliative care.