Intentions and the Doctrine of Double Effect

Abstract

This chapter explores the nature of intention and ‘double effect’ in the moral evaluation of action. It begins with an explanation of the historical origins of the doctrine of double effect (DDE) drawing upon traditional Christian moral thinking and its prominent role in medical ethics. The DDE is regarded as particularly pertinent to palliative care and end of life decisions as it is thought to be a means of distinguishing permissible interventions such as pain relief and sedation from deliberate acts to assist in or bring about death directly. The chapter explores a number of ways in which the DDE can be used in the evaluation of complex moral judgements in end of life care but also points to a number of challenges which must be met if the DDE is to continue to play a role in the ethics of palliative care.