Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

The Doctrine of Double Effect: A Review for the Bedside Nurse Providing End-of-Life Care

Wholihan, Dorothy DNP, AGPCNP-BC, ACHPN, FHPN; Olson, Ellen MD

Journal of Hospice & Palliative Nursing: June 2017 - Volume 19 - Issue 3 - p 205–211
doi: 10.1097/NJH.0000000000000348
Ethics Series

Nurses on the front lines of palliative care are frequently presented with ethically challenging situations involving the use of palliative sedation and increasing opioids at the end of life. The doctrine of double effect is an ethical principle dating back to the 13th century that explains how the bad consequences of an action can be considered ethically justified if the original intent was for good intention. This article examines the doctrine of double effect through case examples and presents supporting and opposing opinions about its relevance to clinical practice. Implications for nursing care are discussed.

Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FHPN, is clinical associate professor, director, Palliative Care NP Specialty Program, Rory Meyers College of Nursing, New York University.

Ellen Olson, MD, is medical director, Palliative Care Program, James J Peters VA Medical Center, Bronx, New York.

Address correspondence to Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FHPN, Rory Meyers College of Nursing, New York University, Rm 533, 433 First Ave, New York, NY 10014 (

The authors have no conflicts of interest to disclose.

© 2017 by The Hospice and Palliative Nurses Association.