Abstract
The rule of double effect has its roots within the Roman Catholic tradition of moral theology. It has a long history of use by bioethicists and philosophers as a means to resolve a particular type of ethical conflict in clinical cases. These cases involve a clinician who must decide whether to act when the proposed action has two known outcomes-one that is desired, desirable, and the intended effect of the action; and another that is neither desired nor intended, although it may be foreseen. Double effect is often cited as justification by clinicians who assume the risk of hastening death as a secondary but unintended effect of providing high-dose opiates to terminally ill and suffering patients. This article examines arguments that support clinical application of double effect and those that criticize its value in facilitating good end-of-life (EOL) decision making. It includes research that illustrates nurses' use and possible misuse of double effect reasoning when providing EOL nursing care. The article concludes with recommendations that clinicians practice thoughtful moral reflection that includes consideration of intentions when providing EOL care.