 Terminal or full sedation is a response to intractable pain in patients suffering from terminal illness. It involves bringing about a set of conditions (sedation, unconsciousness, the absence of hydration and nutrition) that together might have the effect of hastening death if death is not already imminent. In any case, these conditions make death inevitable. Two important moral issues arise concerning this practice. First, is terminal sedation appropriate if it is necessary to relieve intractable pain in patients diagnosed with a terminal illness, even if death is not imminent? This is what Cellarius (2008) calls early terminal sedation because it does not satisfy the requirement that death is imminent that is typically cited as a condition of the permissibility of terminal sedation. Early terminal sedation could be expected to hasten death as a side effect of providing palliative care for unusually recalcitrant pain. A second issue concerns the moral significance of the fact that once sedation has occurred, death is inevitable either because it was imminent already or because the withholding of nutrition and hydration has made it inevitable. Would it be permissible to increase the level of sedation foreseeing that this would hasten the death that is now inevitable? Traditional applications of the principle of double effect rest on the assumption that the death of an innocent human being may never be brought about intentionally and would rule against such an action. Yet the assumptions that inform the popular understanding of double effect — that the physician’s guiding intention is to relieve pain, that the hastening of death would not be unwelcome in these very specific circumstances, and that this course of action should be distinguished from a case of active euthanasia that is not prompted by the duty to relieve pain — might seem to count in favor of it. It may obscure rather than clarify discussion of these situations to view the principle of double effect as a clear guideline. In this discussion, as in many others, the principle of double effect may serve more as a framework for announcing moral constraints on decisions that involve causing death regretfully than as a way of determining the precise content of those decisions and the judgments that justify them. 