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Arima, in the paper ‘Double-effect sedation: do physicians not intend a decrease in consciousness when it is caused by drugs that can also reduce specific symptoms?’, offers a nuanced analysis of moral questions regarding palliative sedation, distinguishing between single effect sedation (SES) and double effect sedation (DES), and effectively challenging the doctrine of double effect (DDE) in justifying DES. He argues against the often justified DES under the DDE in terminally ill patients.1 In what follows, we offer a different justification for rejecting DDE in terminally ill patients receiving sedation.