 Furthermore, the apparently compassionate assumption that the hastening of death is a welcome result may be unduly paternalistic in the context of end of life care in which the patient is not dying. Patients receiving palliative care whose pain can be adequately treated with opioid drugs may well value additional days, hours or minutes of life. It is unjustified to assume that the hastening of death is itself a form of merciful relief for patients with terminal illnesses and not a regrettable side effect to be minimized. Recall that the most plausible formulations of double effect would require agents to seek to minimize or avoid the merely foreseen harms that they cause as side effects. On this point, popular understandings of double effect, with the second assumption in place, may diverge from the most defensible version of the principle. 