The Devil's Choice: Re-Thinking Law, Ethics and Symptom Relief in Palliative Care

29 Pages Posted: 17 May 2006

See all articles by Roger Magnusson

Roger Magnusson

The University of Sydney Law School


It is often assumed, explicitly or implicitly, that the role of medical law and of medical ethics is to guide us towards the "right choice". In this article, I introduce the notion of the "devil's choice": a choice that arises in circumstances where all the options available to the decision-maker are not only unpalatable and unwanted, but are morally perverse to a greater or lesser degree. I use the notion of the devil's choice to re-interpret the conventional legal and ethical account of the provision of symptom relief in palliative care, as illustrated by judgments from the United Kingdom and the United States. In particular, I am critical of the principle of double effect and the moral distinction it seeks to draw between foreseeing, and intending, the consequences of one's actions. The benefit of applying the devil's choice to palliative care is that it permits empathy with the dilemmas physicians face, while still acknowledging the extraordinary power that physicians have over the lives of their patients. Consistent with the devil's choice, I propose requirements for a legal defense of "necessity", where palliative interventions shorten a patient's life.

Keywords: pain, palliative care, sedation, criminal liability, double effect, intention, foresight,

JEL Classification: K14, K42, I12,

Suggested Citation

Magnusson, Roger, The Devil's Choice: Re-Thinking Law, Ethics and Symptom Relief in Palliative Care. Journal of Law, Medicine and Ethics, Vol. 34, No. 3, Fall 2006, Sydney Law School Research Paper No. 06/22, Available at SSRN:

Roger Magnusson (Contact Author)

The University of Sydney Law School ( email )

New Law Building, F10
The University of Sydney
Sydney, NSW 2006

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