Should patients receive general anesthesia prior to extubation at the end of life?

The authors comment on the article "Humane Terminal Extubation Reconsidered: The Role for Preemptive Analgesia and Sedation," by J. A. Billings, that was published within the issue. They enumerate circumstances that allow the use of the Doctrine of Double Effect (DDE) in the U.S. including intending a good effect. They cite the role of the values of a family regarding terminal extubation. They negate the notion that balancing risks is an objective medical decision to be made by the physician.