The Principle of Double Effect in Palliative care: Ethical, Legal, and Clinical Practice Perspectives
1
Public Health, Avicenna - Batumi Medical University, Batumi, Georgia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
the doctrine of double effect (dde) remains a central ethical framework in palliative care, particularly when symptom-relieving interventions may unintentionally shorten life. although debates persist, the dde continues to guide reasoning in distinguishing palliative sedation from euthanasia. this abstract synthesizes current evidence on ethical justification, clinical outcomes, and patient-centred effects related to sedation, symptom control, and quality of life in advanced illness.
METHODS:
a narrative synthesis was performed using findings from multicenter observational studies, randomized controlled trials, meta-analyses, qualitative research, and national surveys on sedation practices, symptom burden, dyspnea management, psychoeducational interventions, and predictors of palliative care effectiveness. outcomes included survival, symptom relief, psychological well-being, and quality of life.
RESULTS:
observational studies showed that palliative sedation did not hasten death, with survival comparable to routine care. national survey data indicated physicians prioritise symptom relief, with few reporting survival-shortening intent. qualitative evidence confirmed ambiguity around intention yet supported ethical differentiation between sedation and euthanasia under the dde. randomized and pooled data showed that early or structured palliative care improved quality of life (smd 0.13), mood, and patient satisfaction, although effects on symptoms and caregiver outcomes were variable. symptom burden remained high across cancers, affecting sleep, emotional well-being, and psychosocial functioning. effective symptom management, psychosocial support, caregiver training, and spiritual care predicted better quality of life. opioids provided clinically meaningful relief of cancer-related dyspnea (smd -0.43) with limited safety concerns.
CONCLUSIONS:
current evidence supports the ethical and clinical relevance of the dde in guiding palliative sedation, which generally does not shorten life and remains distinct from euthanasia through intention and proportionality. comprehensive palliative care—integrating symptom control, psychosocial support, and patient awareness of prognosis—improves quality of life and emotional outcomes. strengthening ethical clarity and standardising sedation practices may enhance patient-centred palliative care globally.
the doctrine of double effect (dde) remains a central ethical framework in palliative care, particularly when symptom-relieving interventions may unintentionally shorten life. although debates persist, the dde continues to guide reasoning in distinguishing palliative sedation from euthanasia. this abstract synthesizes current evidence on ethical justification, clinical outcomes, and patient-centred effects related to sedation, symptom control, and quality of life in advanced illness.
METHODS:
a narrative synthesis was performed using findings from multicenter observational studies, randomized controlled trials, meta-analyses, qualitative research, and national surveys on sedation practices, symptom burden, dyspnea management, psychoeducational interventions, and predictors of palliative care effectiveness. outcomes included survival, symptom relief, psychological well-being, and quality of life.
RESULTS:
observational studies showed that palliative sedation did not hasten death, with survival comparable to routine care. national survey data indicated physicians prioritise symptom relief, with few reporting survival-shortening intent. qualitative evidence confirmed ambiguity around intention yet supported ethical differentiation between sedation and euthanasia under the dde. randomized and pooled data showed that early or structured palliative care improved quality of life (smd 0.13), mood, and patient satisfaction, although effects on symptoms and caregiver outcomes were variable. symptom burden remained high across cancers, affecting sleep, emotional well-being, and psychosocial functioning. effective symptom management, psychosocial support, caregiver training, and spiritual care predicted better quality of life. opioids provided clinically meaningful relief of cancer-related dyspnea (smd -0.43) with limited safety concerns.
CONCLUSIONS:
current evidence supports the ethical and clinical relevance of the dde in guiding palliative sedation, which generally does not shorten life and remains distinct from euthanasia through intention and proportionality. comprehensive palliative care—integrating symptom control, psychosocial support, and patient awareness of prognosis—improves quality of life and emotional outcomes. strengthening ethical clarity and standardising sedation practices may enhance patient-centred palliative care globally.
| eISSN: | 2654-1459 |
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