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The target article makes a valuable contribution to the ethics of palliative care by questioning whether double-effect sedation (DES) can be ethically justified under the doctrine of double effect (DDE). 1 The authors argue that physicians often intend to reduce consciousness, rather than merely accept this as an unfortunate side effect, and therefore DDE cannot ground the legitimacy of DES. This critique is important: it exposes the fragility of an argument that has sometimes been too readily invoked in end-of-life care.