Yet many ethical problems raised by CSD, in which psychosocial
death preceeds the biological death, have already been raised
in the literature. The legitimacy of CSD, especially if deep and not
proportionate, is questioned in case of existential distress. The
primacy given to autonomy is questionable for vulnerable patients
who deserve mainly a social solidarity. The double effect principle
is replaced by a co-intention, putting CSD in a grey zone between
palliation and euthanasia.