Disambiguating clinical intentions: The ethics of palliative sedation

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36 Scopus citations


It is often claimed that the intentions of physicians are multiple, ambiguous, and uncertain - at least with respect to end-of-life care. This claim provides support for the conclusion that the principle of double effect is of little or no value as a guide to end-of-life pain management. This paper critically discusses this claim. It argues that proponents of the claim fail to distinguish two different senses of "intention," and that, as a result, they are led to exaggerate the extent to which clinical intentions in end-of-life contexts are ambiguous and uncertain. It argues further that physicians, like others who make life and death decisions, have a duty to get clear on what their intentions are. Finally, it argues that even if the principle of double effect should be rejected, clinical intentions remain ethically significant because they condition the meaning of extraordinary clinical interventions, such as that of palliative sedation.

Original languageEnglish (US)
Pages (from-to)19-31
Number of pages13
JournalJournal of Medicine and Philosophy
Issue number1
StatePublished - Feb 2010
Externally publishedYes


  • Double effect
  • Intention
  • Intentionality palliative sedation

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Philosophy


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