The principle of double effect – also known as the rule of double effect; the doctrine of double effect, often abbreviated as DDE or PDE, double-effect reasoning; or simply double effect – is a set of ethical criteria which Christian philosophers have advocated for evaluating the permissibility of acting when one's otherwise legitimate act may also cause an effect one would otherwise be obliged to avoid. The first known example of double-effect reasoning is
Thomas Aquinas
Thomas Aquinas, OP (; it, Tommaso d'Aquino, lit=Thomas of Aquino; 1225 – 7 March 1274) was an Italian Dominican friar and priest who was an influential philosopher, theologian and jurist in the tradition of scholasticism; he is known wi ...
' treatment of homicidal self-defense, in his work ''
Summa Theologica
The ''Summa Theologiae'' or ''Summa Theologica'' (), often referred to simply as the ''Summa'', is the best-known work of Thomas Aquinas (1225–1274), a scholasticism, scholastic theologian and Doctor of the Church. It is a compendium of all ...
''.
This set of criteria states that an action having foreseen harmful effects practically inseparable from the good effect is justifiable if the following are true:
* the nature of the act is itself good, or at least morally neutral;
* the agent intends the good effect and does not intend the bad effect, either as a means to the good or as an end in itself;
* the good effect outweighs the bad effect in circumstances sufficiently grave to justify causing the bad effect and the agent exercises due diligence to minimize the harm.
Intentional harm vis-à-vis side effects
The principle of double effect is based on the idea that there is a morally relevant difference between an "intended" consequence of an act and one that is foreseen by the actor but not calculated to achieve their motive. So, for example, the principle is invoked to hold as ethically out of bounds the terror bombing of non-combatants having as its goal victory in a legitimate war, while holding as ethically in bounds an act of strategic bombing that similarly harms non-combatants with foresight as a side effect of destroying a legitimate military target. Because advocates of double effect propose that consequentially similar acts can be morally different, double effect is most often criticized by
consequentialists
In ethical philosophy, consequentialism is a class of normative ethics, normative, Teleology, teleological ethical theories that holds that the wikt:consequence, consequences of one's Action (philosophy), conduct are the ultimate basis for judgm ...
who consider the consequences of actions entirely determinative of the action's morality.
In their use of the distinction between intent and foresight without intent, advocates of double effect make three arguments. First, that intent differs from foresight, even in cases in which one foresees an effect as inevitable. Second, that one can apply the distinction to specific sets of cases found in military ethics (terror bombing/strategic bombing), medical ethics (craniotomy/hysterectomy), and social ethics (euthanasia). Third, that the distinction has moral relevance, importance, or significance.
The doctrine consists of four conditions that must be satisfied before an act is morally permissible:
# The ''nature-of-the-act condition.'' The action, apart from the foreseen evil, must be either morally good or indifferent.
# The ''means-end condition.'' The bad effect must not be the means by which one achieves the good effect. Good ends do not justify evil means.
# The ''right-intention condition.'' The intention must be the achieving of only the good effect, with the bad effect being only an unintended side effect. All reasonable measures to avoid or mitigate the bad effect must be taken.
# The ''proportionality condition.'' There must be a proportionately grave reason for permitting the evil effect.
Medicine
The principle of double effect is frequently cited in cases of
pregnancy
Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occurs by sexual intercourse, but ca ...
and
indirect abortion
Indirect abortion is the name given by Catholic theologians to a medical procedure which has a beneficial medical effect and also results in an abortion as a secondary effect. Edwin F. Healy makes a distinction between "direct abortions" that is, ...
. A doctor who believes abortion is always morally wrong may still remove the uterus or
fallopian tube
The fallopian tubes, also known as uterine tubes, oviducts or salpinges (singular salpinx), are paired tubes in the human female that stretch from the uterus to the ovaries. The fallopian tubes are part of the female reproductive system. In ot ...
s of a pregnant woman, knowing the procedure will cause the death of the
embryo
An embryo is an initial stage of development of a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male spe ...
or
fetus
A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal deve ...
, in cases in which the woman is certain to die without the procedure (examples cited include aggressive
uterine
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the hollow organ, organ in the female reproductive system, reproductive system of most female mammals, including humans that accommodates the embryonic development, embryonic an ...
cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
and
ectopic pregnancy
Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. ...
). In these cases, the intended effect is to save the woman's life, not to terminate the pregnancy, and the effect of not performing the procedure would result in the greater evil of the death of both the mother and the fetus.
In cases of terminally ill patients who would hasten their deaths because of unbearable pain, or whose caregivers would do so for them (
euthanasia
Euthanasia (from el, εὐθανασία 'good death': εὖ, ''eu'' 'well, good' + θάνατος, ''thanatos'' 'death') is the practice of intentionally ending life to eliminate pain and suffering.
Different countries have different eut ...
, medical aid in dying, etc.), a principle of "double effect death" could be applied to justify the deliberate administration of a pain-killer in potentially unsafe doses – not in an attempt to end life but to relieve the pain suffered as it is considered harmful to the patient. The
U.S. Supreme Court
The Supreme Court of the United States (SCOTUS) is the highest court in the federal judiciary of the United States. It has ultimate appellate jurisdiction over all U.S. federal court cases, and over state court cases that involve a point o ...
has voiced support for this principle in its deliberations over the constitutionality of medical aid in dying.
['' Vacco v. Quill'' and '']Washington v. Glucksberg
''Washington v. Glucksberg'', 521 U.S. 702 (1997), was a landmark decision of the U.S. Supreme Court, which unanimously held that a right to assisted suicide in the United States was not protected by the Due Process Clause.
Background
Dr. Harold ...
'', both in 1997. See: Tucker, Kathryn E., “Legal Advocacy to Improved Care and Expand Options at the End of Life,” in ''Physician-Assisted Dying: The Case for Palliative Care & Patient Choice'', edited by T.E. Quill and M.P. Battin (Johns Hopkins University Press
The Johns Hopkins University Press (also referred to as JHU Press or JHUP) is the publishing division of Johns Hopkins University. It was founded in 1878 and is the oldest continuously running university press in the United States. The press publi ...
, 2004). The Court made it clear that a “medical death” hastened by palliative measures was permissible.
Criticisms
Consequentialists
In ethical philosophy, consequentialism is a class of normative ethics, normative, Teleology, teleological ethical theories that holds that the wikt:consequence, consequences of one's Action (philosophy), conduct are the ultimate basis for judgm ...
, in particular, reject the notion that two acts can differ in their moral permissibility if both have exactly the same consequences, or expected consequences.
John Stuart Mill
John Stuart Mill (20 May 1806 – 7 May 1873) was an English philosopher, political economist, Member of Parliament (MP) and civil servant. One of the most influential thinkers in the history of classical liberalism, he contributed widely to ...
, a nineteenth-century advocate of the
utilitarian
In ethical philosophy, utilitarianism is a family of normative ethical theories that prescribe actions that maximize happiness and well-being for all affected individuals.
Although different varieties of utilitarianism admit different charac ...
version of consequentialism, argues that it is a mistake to confuse the standards for right action with a consideration of our motives to perform a right action: "He who saves a fellow creature from drowning does what is morally right, whether his motive be duty, or the hope of being paid for his trouble; he who betrays the friend that trusts him, is guilty of a crime, even if his object be to serve another friend to whom he is under greater obligations." According to Mill, scrutiny of motives will show that almost all good behavior proceeds from questionable intentions. Therefore, Mill argues, our moral analysis should ignore matters of motivation, and so we should reject DDE, which appeals to a distinction between intended and
unintended consequences
In the social sciences, unintended consequences (sometimes unanticipated consequences or unforeseen consequences) are outcomes of a purposeful action that are not intended or foreseen. The term was popularised in the twentieth century by Ameri ...
.
[John Stuart Mill, '']Utilitarianism
In ethical philosophy, utilitarianism is a family of normative ethical theories that prescribe actions that maximize happiness and well-being for all affected individuals.
Although different varieties of utilitarianism admit different charact ...
'' (London: Parker, Son and Bourn, 1863), page 26. Mill further claims that scrutiny of motives will reveal a man's character, but utilitarianism does not judge character, only the rightness or wrongness of actions.
See also
*
Trolley problem
The trolley problem is a series of thought experiments in ethics and psychology, involving stylized ethical dilemmas of whether to sacrifice one person to save a larger number. The series usually begins with a scenario in which a runaway tram or ...
– a moral dilemma exploring the principle of double effect
*
Competing harms Competing harms is a legal doctrine in certain U.S. states, particularly in New England. For example, the Maine Criminal Code holds that "Conduct that the person believes to be necessary to avoid imminent physical harm to that person or another is j ...
and
necessity
Necessary or necessity may refer to:
* Need
** An action somebody may feel they must do
** An important task or essential thing to do at a particular time or by a particular moment
* Necessary and sufficient condition, in logic, something that is ...
– similar theories in law
*
Lesser of two evils principle
The lesser of two evils principle, also referred to as the lesser evil principle and lesser-evilism, is the principle that when faced with selecting from two immoral options, the least immoral one should be chosen. The principle is sometimes rec ...
References
External links
Stanford Encyclopedia of Philosophy entryPhilPapers Bibliography: 'Doctrine of Double Effect'
{{DEFAULTSORT:Principle Of Double Effect
Bioethics
Thomism
Ethical principles
Catholic Church and abortion