The expert management of pharmacological and non-pharmacological treatments is essential to the concept of proportionality. When physicians use appropriate analgesics and write orders to titrate medication based on evidence of pain and suffering, such as groaning, agitation, verbal complaints, diaphoresis, hypertension, or unexplained tachycardia, they demonstrate that the intention of the act is geared toward alleviating pain. Until relatively recently, dying patients were routinely under-treated for pain because physicians feared that the treatment would hasten death. This chapter explains the case study of a 58-year-old woman with widely metastatic breast cancer. In the context of caring for a terminally ill patient, the double effect (DE) allows for good pain management. DE asks physicians to carefully examine their motives and assumes that one's private moral intentions are morally relevant. The principle of double effect permits aggressive treatment of pain when death may be an unintended effect of that treatment.