As an oncology nurse educator, I've heard nurses say that they're not comfortable with the so-called double effect of opioids administered to manage pain at the end of life. They're questioning whether this is comfort care oreuthanasia. What are your thoughts?-E.B., MICH.

It's a matter of intention. By giving an opioid to ease pain, the nurse's motive is to relieve suffering, not to kill.

A clear definition of "double effect" may help nurses understand this distinction. One effect of administering an opioid is to relieve pain or suffering; this is the intended effect. But administering an opioid may also have a second, unintended effect, which is to depress respiration and possibly shorten life.

Don't confuse this double effect with active euthanasia, which is both illegal and immoral. The patient's death results from his disease, not the treatment. The nurse's moral mandate is to relieve suffering at the end of life, even if that life may be shortened as a consequence of treatment.