¡¡¡¡The Supreme Court¡¯s decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering.ª¥

¡¡¡¡Although it ruled that there is no constitutional right to physician-assisted suicide, the Court in effect supported the medical principle of ¡°double effect," a centuries-old moral principle holding that an action having two effects¡ªa good one that is intended and a harmful one that is foreseen¡ªis permissible if the actor intends only the good effect.ª¥

¡¡¡¡Doctors have used that principle in recent years to justify using high doses of morphine to control terminally ill patients¡¯ pain, even though increasing dosages will eventually kill the patient.ª¥

¡¡¡¡Nancy Dubler, director of Montefiore Medical Center, contends that the principle will shield doctors who ¡°until now have very, very strongly insisted that they could not give patients sufficient mediation to control their pain if that might hasten death."ª¥

¡¡¡¡George Annas, chair of the health law department at Boston University, maintains that, as long as a doctor prescribes a drug for a legitimate medical purpose, the doctor has done nothing illegal even if the patient uses the drug to hasten death. ¡°It¡¯s like surgery," he says. ¡°We don¡¯t call those deaths homicides because the doctors didn¡¯t intend to kill their patients, although they risked their death. If you¡¯re a physician, you can risk your patient¡¯s suicide as long as you don¡¯t intend their suicide."ª¥