In what circumstances does the doctrine, rule, or principle of double effect (PDE) apply? The common use of the PDE occurs when providing pain relief and comfort at the end of life. By using opiate analgesics and sedatives to provide comfort to a dying patient, we risk depressing respirations and causing hypotension, which may hasten death. According to the PDE, the outcome for which the healthcare provider can be held responsible is the intended outcome, not the outcome that is foreseen but not intended.11,33 For example, when a nurse administers morphine and/or lorazepam to a dying patient, the intended outcome is to provide comfort by relieving pain and anxiety. While the nurse may realize that the patient could die more quickly as a result of these medications, since this result is not the...

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