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Related Experiment Video

Updated: Jun 2, 2026

A Pacing-Controlled Procedure for the Assessment of Heart Rate-Dependent Diastolic Functions in Murine Heart Failure Models
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Double effect: a useful rule that alone cannot justify hastening death.

J Andrew Billings1

  • 1jandrew.billings@gmail.com

Journal of Medical Ethics
|April 12, 2011
PubMed
Summary

The rule of double effect is often misapplied in end-of-life care discussions. Its ethical justification requires deeper moral theory, not just the rule itself, for clinical acts that may hasten death.

Area of Science:

  • Bioethics
  • Medical Ethics
  • Philosophy of Medicine

Background:

  • The rule of double effect is frequently cited in ethical debates concerning palliative sedation and terminal extubation.
  • Current literature often presents this rule as a definitive moral arbiter for clinical actions that may hasten death in imminently dying patients.

Purpose of the Study:

  • To critically analyze the application of the rule of double effect in end-of-life medical practices.
  • To argue that the rule necessitates explicit moral theories for its appropriate justification.
  • To explore the limited relevance of the rule to physician-assisted suicide and voluntary active euthanasia debates.

Main Methods:

  • Conceptual analysis of the rule of double effect.
  • Examination of ethical theories underpinning the rule's tenets.

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  • Review of literature on end-of-life ethics and related debates.

    • Main Results:

    • The rule of double effect, while useful, does not provide a complete ethical justification on its own.
    • Each of the rule's four tenets requires independent moral grounding.
    • The rule has limited applicability to physician-assisted suicide and voluntary active euthanasia.

    Conclusions:

    • The ethical acceptability of clinical acts that may hasten death requires moral theories beyond the rule of double effect.
    • A pluralistic society necessitates diverse moral frameworks for evaluating such practices.
    • The rule of double effect's relevance is context-dependent and requires explicit justification for its application.