TY - JOUR T1 - Ethical end-of-life palliative care: response to Riisfeldt JF - Journal of Medical Ethics JO - J Med Ethics SP - 51 LP - 52 DO - 10.1136/medethics-2019-105451 VL - 46 IS - 1 AU - Heidi Giebel Y1 - 2020/01/01 UR - http://jme.bmj.com/content/46/1/51.abstract N2 - In a recent article,1 Riisfeldt attempts to show that the principle of double effect (PDE) is unsound as an ethical principle and problematic in its application to palliative opioid and sedative use in end-of-life care. Specifically, he claims that (1) routine, non-lethal opioid and sedative administration may be “intrinsically bad” by PDE’s standards, (2) continuous deep palliative sedation (or “terminal sedation”) should be treated as a bad effect akin to death for purposes of PDE, (3) PDE cannot coherently be applied in cases where death “indirectly” furthers an agent’s intended end of pain relief via medically appropriate palliative care, and (4) application of PDE requires sacrificing common beliefs about the sanctity of human life. I respond by showing that Riisfeldt’s understanding of PDE is seriously mistaken: he misattributes Kantian and Millian reasoning to the principle and conflates acts’ intrinsic properties with their effects. Further, a corrected understanding of PDE can address Riisfeldt’s case-specific objections. ER -