Non-consequentialist Theory of Proportionality: With Reference to the Ethical Controversy over Sedation in Terminal Care

In medical practice, ethical conflicts frequently occur between the principle of beneficence and the principle of non-maleficence, and if we accept these two principles without any modification, it is impossible for us to comply with both simultaneously in many cases. Thus, in order to make the two principles consistent, it is necessary to provide a means of interpretation, or a set of rules, that can be used to adjust between the two principles and prevent such conflicts or dilemmas from occurring. The “principle of double effect” was introduced to play this role. The theory of double effect, standing on the non-consequentialist and non-relativist viewpoint, has been a popular means of decision-making in medical practice, but has recently been criticized, especially by consequentialists, who have proposed the theory of proportionality instead. One topic that reflects the controversy between the two theories is the ethical evaluation of sedation for terminally ill patients with intolerable pain or suffering. The author examines the two theories with reference to discussion on sedation in palliative care, and though declaring the theory of proportionality the winner, proposes a revised theory of proportionality, or a relativized theory of beneficence, retaining a non-consequentialist