The double life of double effect

Area of Science:

• Medical Ethics
• Philosophy of Medicine
• Legal Medicine

Background:

• The U.S. Supreme Court in Vacco v. Quill invoked the principle of double effect.
• This principle is used to justify hastening death in palliative care, including terminal sedation.
• The doctrine distinguishes between intended harm and harm as a side effect.

Purpose of the Study:

• To analyze the application of the double effect principle in palliative care.
• To critically evaluate its use in justifying terminal sedation.
• To propose an alternative approach for acute palliative care.

Main Methods:

• Philosophical analysis of the doctrine of double effect.
• Examination of legal reasoning in Vacco v. Quill.
• Distinguishing between instrumental and incidental harm.

Main Results:

• The double effect principle may justify ordinary palliative care.
• Its application to terminal sedation is questionable and lacks coherence.
• The traditional prohibition on hastening death as a means to relieve suffering needs reevaluation.

Conclusions:

• The doctrine of double effect is not a sufficient justification for terminal sedation.
• A revised understanding of double effect is needed for acute palliative care.
• The prohibition on hastening death requires reconsideration in specific contexts.