A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: double-effect sedation, parsimonious direct sedation, and sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices (...) are defined clearly and evaluated ethically. It is concluded that, if one is opposed to euthanasia and assisted suicide, double-effect sedation can frequently be ethically justified, that parsimonious direct sedation can be ethically justified only in extremely rare circumstances in which symptoms have already completely consumed the patient’s consciousness, and that sedation to unconsciousness and death is never justifiable. The special case of sedation for existential suffering is also considered and rejected. (shrink)

This essay argues on behalf of a hybrid theory for an ethics of self-defense understood as the Forfeiture-Partiality Theory. The theory weds the idea that a malicious attacker forfeits the right to life to the idea that we are permitted to prefer one's life to another's in cases of involuntary harm or threat. The theory is meant to capture our intuitions both about instances in which we can draw a moral asymmetry between attacker and victim and cases in which we (...) cannot. I develop the theory by attending to instances of intentional, villainous harm and instances of involuntary danger—the latter of which are a matter of bad luck. I call some bad luck cases "Interpersonal Lottery Conflicts." These cases refer to potentially lethal conflicts into which parties are thrown as victims of circumstance. Although neither party has a moral advantage over another, that fact does not preclude permissible self-defense. (shrink)