The rule of double effect: clearing up the double talk.

R ECENTLY, the rule of double effect, which has a long history in ethics, especially medical ethics, has come under serious criticism in the medical literature. Because of its immense practical importance in the care of dying patients, any attack on this rule must be taken seriously. In this article, therefore, we present a systematic rejoinder to what we take to be serious misunderstandings of the nature and use of this rule. A clear understanding of the proper use of the rule of double effect is essential if health care professionals are to maintain their opposition to euthanasia and assisted suicide and yet provide adequate pain relief to dying patients. Many Americans, including health care professionals, are fearful of unwittingly participating in euthanasia if a patient’s death is hastened, however unintentionally, as a side effect of attempts to relieve pain and suffering. For such individuals, the rule of double effect provides moral reassurance and thus encourages optimal care of the dying. This is why the rule figures prominently in the opinions of the American Medical Association.