ABSTRACT
Medical ethicists place great weight on the intentions of clinical actions. The religious principle of "double effect," based on a distinction between intentions and consequences, is an ethical cornerstone in the medical treatment of the terminally ill.1 , 2 Giving high doses of narcotic analgesics to a dying patient to relieve pain and suffering is considered ethical even if it inadvertently hastens death, provided the clinician did not intend to help the patient die. Death may even be foreseen as a side effect of the intervention as long as it is not intended. On the other hand, should a clinician remotely intend to help a patient die, even when death is desired by a terminally ill patient with irreversible suffering, that same act would be considered unethical — a form of medical killing.3
