Which statement best describes the ethical basis for using high-dose analgesia near death when it relieves suffering?

• A. It is always unethical, as it hastens death.
• B. The patient must be cured first.
• C. The best effective care is to relieve suffering, even if death might occur as a side effect.
• D. It should never be discussed with family.

Answer: (C)

Relieving suffering through high-dose analgesia near the end of life rests on the principle that the primary intention is to ease pain and distress, even if that treatment carries a possible, unintended risk of shortening life. This is the double effect idea: the good outcome (pain relief) is the intended goal, while any potential life-shortening effect is a foreseen but undesired side effect, not the aim of the intervention. In practice, this means using opioids or other analgesics at doses sufficient to relieve severe suffering, with careful monitoring and in discussion with the patient (and family or surrogates), ensuring the treatment is appropriate, proportionate, and aimed at comfort rather than hastening death.

Choice that emphasizes always unethical to relieve suffering is not consistent with palliative ethics, which prioritize comfort; the idea that cure must come first ignores the reality that relief of suffering can be the immediate and ethically sound goal. The notion that discussions should never involve family conflicts with principles of shared decision-making and informed consent, which are integral to respectful end-of-life care.