Is the doctrine of double effect irrelevant in end-of-life decision making?

Nursing Philosophy

Volumn 11, Issue 3, 2010, Pages 170-177

  Allmark, Peter ^a   Cobb, Mark ^b   Liddle, B Jane ^c   Tod, Angela Mary ^a  

^a SHEFFIELD HALLAM UNIVERSITY   (United Kingdom)

^b SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST   (United Kingdom)

^c NORTHERN GENERAL HOSPITAL   (United Kingdom)

Author keywords

Diagnosis of dying; Doctrine of double effect; End of life; Ethics; Euthanasia; Physician assisted death

Indexed keywords

NARCOTIC ANALGESIC AGENT;

ARTICLE; ASSISTED SUICIDE; CONSCIOUS SEDATION; DECISION MAKING; ETHICS; EUTHANASIA; HUMAN; LEGAL ASPECT; MEDICAL ETHICS; TERMINAL CARE; TIME; UNITED KINGDOM; LEGISLATION AND JURISPRUDENCE;

ANALGESICS, OPIOID; CHOICE BEHAVIOR; CONSCIOUS SEDATION; DECISION MAKING; DOUBLE EFFECT PRINCIPLE; EUTHANASIA; GREAT BRITAIN; HUMANS; SUICIDE, ASSISTED; TERMINAL CARE; TIME FACTORS;

EID: 77954596716     PISSN: 14667681     EISSN: 1466769X     Source Type: Journal    
DOI: 10.1111/j.1466-769X.2009.00430.x     Document Type: Article

References (34)

1. Beauchamp T, Childress J. Principles of Biomedical Ethics 2001, Oxford University Press, New York
2. Withholding and Withdrawing Life-Prolonging Medical Treatment: Guidance for Decision Making 2007, British Medical Association, 3rd, edn., Blackwell, Oxford
3. Carr MF, Mohr GJ. Palliative sedation as part of a continuum of palliative care. Journal of Palliative Medicine 2008, 11(1):76-81.
4. Cavanaugh T. The intended/foreseen distinction's ethical relevance. Philosophical Papers 1996, 25(3):179-188.
5. Cavanaugh T. Double-Effect Reasoning: Doing Good and Avoiding Evil 2006, Clarendon Press, Oxford
6. Chappell T. Two distinctions that do make a difference: the action/omission distinction and the principle of double effect. Philosophy 2002, 77(2):211-233.
7. De Graeff A, Dean M. Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. Journal of Palliative Medicine 2007, 10(1):67-85.
8. End of Life Care Strategy 2008, Department of Health, Department of Health, London
9. Care of the Dying: A Pathway to Excellence 2003, Ellershaw JWilkinson S. eds, Oxford University Press, Oxford
10. Ellershaw J, Ward C, Neuberger J. Care of the dying patient: the last hours or days of life (Commentary). British Medical Journal 2003, 326(7379):30-34.
11. Forbes K, Huxtable R. Clarifying the data on double effect. Palliative Medicine 2006, 20(4):395-396.
12. Gillon R. When doctors might kill their patients: foreseeing is not necessarily the same as intending. BMJ (Clinical Research Ed 1999, 318(7196):1431-1432.
13. Good PD, Ravenscroft PJ, Cavenagh J. Effects of opioids and sedatives on survival in an australian inpatient palliative care population. Internal Medicine Journal 2005, 35(9):512-517.
14. Grubb A. Principles of Medical Law 2004, ed., 2nd, edn., OUP, Oxford
15. Mental Capacity Act. 2006, http://www.opsi.gov.uk/ACTS/acts2005/ukpga_20050009_en_1, HMSO, [online]. London, HMSO. Retrieve 30 December 2009, from
16. Kennedy I, Grubb A. Medical Law: Text and Materials 2000, Butterworth, London
17. Kenny A. Intention and purpose. The Journal of Philosophy 1966, 63:642-651.
18. Levy MH, Cohen SD. Sedation for the relief of refractory symptoms in the imminently dying: a fine intentional line. Seminars in Oncology 2005, 32(2):237-246.
19. Lo B, Rubenfeld G. Palliative sedation in dying patients: 'we turn to it when everything else hasn't worked'. JAMA: The Journal of the American Medical Association 2005, 294(14):1810-1816.
20. The ethics of palliative sedation as a therapy of last resort. American Journal of Hospice & Palliative Medicine 2007, 23(6):483-491. National Ethics Committee & Veterans' Health Association
21. Improving Supportive and Palliative Care for Adults with Cancer 2004, National Institute for Health and Clinical Excellence, National Institute for Clinical Excellence, London
22. Price D. Euthanasia, pain relief and double effect. Legal Studies 1997, 17(2):323-342.
23. Quill TE, Lo B, Brock DW. Palliative options of last resort: a comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia. JAMA: The Journal of the American Medical Association 1997, 278(23):2099-2104.
24. Samanta A, Samanta J. The Human Rights Act 1998 - why should it matter for medical practice? Journal of the Royal Society of Medicine 2005, 98(9):404.
25. Seale C. Characteristics of end-of-life decisions: survey of UK medical practitioners. Palliative Medicine 2006a, 20(7):653-659.
26. Seale C. National survey of end-of-life decisions made by UK medical practitioners. Palliative Medicine 2006b, 20(1):3-10.
27. Sykes N, Thorns A. Sedative use in the last week of life and the implications for end-of-life decision making. Archives of Internal Medicine 2003a, 163(3):341-344.
28. Sykes N, Thorns A. The use of opioids and sedatives at the end of life. The Lancet Oncology 2003b, 4(5):312-318.
29. Taylor RM. Is terminal sedation really euthanasia? Medical Ethics (Burlington, Mass.) 2003, 10(1):3-8.
30. A new homicide act for England and Wales? 2005, http://www.lawcom.gov.uk/docs/cp177_web.pdf, The Law Commission, A Consultation Paper. [online]. London, Law Commission. Retrieved 19 March 2009, from
31. Thorns A. Sedation, the doctrine of double effect and the end of life. International Journal of Palliative Nursing 2002, 8(7):341-343.
32. Tur RH. Just how unlawful is " euthanasia" ? Journal of Applied Philosophy 2002, 19(3):219-232.
33. Watt H. Conjoined twins: separation as mutilation. Medical Law Review 2001, 9(3):237.
34. Williams G. The principle of double effect and terminal sedation. Medical Law Review 2001, 9(1):41.