According to that principle, physicians may take steps that might hasten the patient's death as long as the steps constitute a reasonable effort to treat the patient's suffering and the patient's death is not intended. For example, it is permissible to give analgesics or sedatives to alleviate a patient's pain even if the drugs might halt the patient's breathing. However, the principle of the double effect justifies only the sedation that is part of terminal sedation. We cannot justify the withdrawal of food and water during terminal sedation, for that step does nothing to relieve the patient's suffering but only serves to bring about the patient's death. If it is argued that the withdrawal of food and water is a permissible act, then we are back to the previous response that it is permissible only because the patient's inability to eat or drink results from an underlying disease.
Terminal sedation poses the same risks of abuse as assisted suicide or euthanasia.
To see how terminal sedation carries the same risks as assisted suicide or euthanasia, we can consider a twist on the case of Jane Adkins, the woman with early Alzheimer's disease who became the first person to die with Dr. Jack Kevorkian's assistance. Let us assume that Ms. Adkins expressed her despair and her desire to consult Dr. Kevorkian to her personal physician. Suppose, further, that, in response, Ms. Adkins's physician suggested that she consider terminal sedation accompanied by the withholding of nutrition and hydration. If we are troubled by Ms. Adkins's suicide at the hands of Dr. Kevorkian, then we should be equally troubled if she had undergone terminal sedation at the hands of her personal physician. Like assisted suicide or euthanasia, terminal sedation can be provided to people whose illnesses are not yet serious or whose suffering results from a treatable depression.