Other Relevant Ethical Principles

Principle of Double Effect

 Thomas Aquinas (1225–1274)
 An intellectual and religious
revolutionary.
 He was a member of the Dominican
Friars.
 Taught by one of the greatest intellects
of the age, Albert the Great (1208–
1280).
 His most famous work is Summa
Theologica
 runs to some three and half thousand
pages and contains many fascinating
and profound insights, such as proofs for
God’s existence
 Motivating Natural Law Theory: The Euthyphro
Dilemma and Divine Command Theory
 Divine Command Theory
 Drawing link between what is right
and wrong and what God commands
and forbids
 Euthyphro Dilemma
 The dilemma runs as follows: Either
God commands something is right
because it is, or it is right because God
commands it. If God commands
something because it is right, then
God’s commands do not make it right,
His commands only tell us what is
right.
Natural Law Theory

 Aquinas’s Natural Law Theory contains four different types of law:

 Eternal Law
 means God’s rational purpose and plan for all things
 Natural Law
 act according to reason
 Human Law
 discovered through rational reflection and created by people
 Divine Law
 discovered through revelation
Example of Primary Percepts

 Protect and preserve human life.

 Reproduce and educate one’s offspring.

 Know and worship God.

 Live in a society.

 These precepts are primary because they are true for all people in all instances and
are consistent with Natural Law.
Doctrine/ Principle of Double Effect

 Aquinas introduces one of his most famous ideas: the “Doctrine of Double Effect”.
Let’s see how this works.
 Imagine a child brought up in a physically, sexually and emotionally abusive family. He is
frequently scared for his life and is locked in the house for days at a time. One day when
his father is drunk and ready to abuse him again, he quickly grabs a kitchen knife and
slashes his father’s artery. His father bleeds out and dies in a matter of minutes. Do you
think the son did anything wrong?
Definition of the Principle of Double Effect

 A principle that purports to answer the following question

 Is it right to perform an action from which two or more effects result. Some of which are
good and may rightly be intended and some of which are bad and may not rightly be
intended?

 One act can embrace two effects – an intended good effect and an unintended bad
effect
The Four Conditions of the Principle of Double
effect

1. The act-in-itself must not be morally wrong.

2. The bad effect must not cause the good effect.

3. The agent must not intend the bad effect (as an end to be sought).

4. The bad effect must not outweigh the good effect.

Let’s go back to our example

 Imagine a child brought up in a physically, sexually and emotionally abusive family.

He is frequently scared for his life and is locked in the house for days at a time. One
day when his father is drunk and ready to abuse him again, he quickly grabs a
kitchen knife and slashes his father’s artery. His father bleeds out and dies in a
matter of minutes. Do you think the son did anything wrong?
1. The act of the son was performed to save his own life so that is good.

2. The act to save his life came about first.

3. The son did not first act to kill his father in order to save his own life. That would be
doing evil to bring about good and that is never morally acceptable. The intention
of the son was to preserve and protect his life, so the intention was good.

4. The reasons were serious as it was his life or his father’s life.
Classic Example

 The terminally ill pulmonary patient who is experiencing both great pain and a low
respiratory rate. The treatment of choice, injecting morphine sulfate, will quell the
pain but might also “quell” the respiratory rate. The nurse has a moral duty to
prevent and remove evil (pain) that appears to conflict with the duty to benefit
patients (protect and preserve life), a dilemma indeed. The answer to the question
of whether the nurse may administer morphine is clearly YES.
 Applying the criteria of double effect illustrates why this is so:

1. The action of giving an injection of morphine is itself morally different or good.

2. The intended effect is to relieve the pain, not to depress the respirations.

3. Respiratory depression is not the means by which the pain relief is obtained.

4. The relief of pain and the related reduction of suffering combine to provide a
sufficiently important reason, or proportionately greater good than the harm that
is incurred- respiratory depression and likely death (Schwarz, 2004b).
Another Example
 Imagine that a woman is pregnant and has inoperable uterine cancer. The doctors have two
choices; to take out the uterus and save the mother, but the fetus will die; or leave the fetus
to develop and be born healthy, but the woman will die. Is it morally acceptable to remove
the cancer?

 The action is to remove the cancer; it has the foreseeable consequences of the fetus dying
but that is not what is intended.

1. The action — to remove the cancer — is good.

2. The act of removing the cancer comes before the death of the fetus.

3. The intention to save the woman’s life is also good.

4. Finally, the reasons are serious as they are about the life and death of the woman and the
fetus.
Application of the Principle of Double effect

 Abortion  Breaching Confidentiality

 Ectopic Pregnancy  Palliative Care

 Euthanasia  Separation of Conjoined Twins

 Mutilation

 Sterility Issues

 Mental Reservation

 Cooperation in an Evil Act

Legal recognition of doctrine of double
effect

 R v Bodkin Adams (1957)

 GP acquitted of murder by administration of increasing doses of
opiates to elderly patients.
 Devlin, J (judge) introduced double effect doctrine:
if the first purpose of medicine, the restoration of health, could no
longer be achieved, there was still much for the doctor to do, and he
was entitled to do all that was proper and necessary to relieve pain
and suffering even if the measures he took might incidentally
shorten life”
Legal recognition of doctrine of double
effect (cont)

 Airedale NHS v Bland (1993)

 Lord Goff “.[It is] the established rule that a doctor may, when caring
for a patient, who is, for example, dying of cancer, lawfully
administer painkilling drugs despite the fact that he knows that an
incidental effect of that application will be to abbreviate the patient’s
life …Such decisions may properly be made as part of the care of
the living patient, in his best interest; and, on this basis, the
treatment will be lawful”.
Legal recognition of doctrine of double effect -
problems

 Contrary to traditional notions of criminal law intention and causation

 Airedale NHS Trust v Bland (1993)

 concern expressed about dubious demarcation between primary (direct) and
secondary (oblique) intention
Legal recognition of doctrine of double
effect – problems (cont)
 Double effect – is it hypocrisy ?

- isn’t the actor who foresees the consequences of an action

acting intentionally and therefore culpable or responsible for
the act and its outcome ?
Principle of Legitimate
Cooperation
The principle of cooperation

 Portrays the Principle of the Double Effect in a scenario in which more than
one person participates in the actions being evaluated.

 COOPERATION is working with another in the performance of an action.

 The degree of cooperation may vary according to the gravity or essentiality

of the shared act in the performance of an evil action.
Formal Cooperation

 Occurs when one assents to the evil intention of the person mainly
responsible for performing the evil action.

 Consists of an explicit intention and willingness for the evil act. The one
formally cooperating categorically wills and intends the evil action.

 May occur if one advises, encourages, or counsels the person principally

responsible for the evil action, even though one does not take part physically
in the action.
Material Cooperation

 Consists of an act other than the evil act itself but facilitates and contributes to its
achievement.

 The one materially cooperating may provide means apart from the evil act itself
which is used to carry out the performance of an evil act.

 Types
 Immediate material cooperation
 Mediate material cooperation
Immediate Material Cooperation

 If one’s action contributes to the active performance of the evil action so much so
that the evil action could not be performed without the help of the cooperator.

 This method of cooperation involves the cooperator acting in conjunction with the
person primarily responsible for the evil action.

 If the act in question is intrinsically evil, then immediate material cooperation is

always prohibited.
Mediate Material Cooperation

 If one’s cooperation is not needed to perform the evil action, but only assists in the
performance of the action.

 This type of material cooperation may be justified if there is a serious reason for it
because the action on the part of the cooperator is fundamentally good.
Moral rules governing cooperation

a. No one should formally and directly cooperate in the performance of an evil

action.

b. If a reason sufficiently grave exists, material cooperation in the performance of an

evil action may be morally excused.

c. If the material cooperation is proximate, a reason sufficiently graver should exist

to be morally excused without which evil is incurred.
Principle of Common Good and
Subsidiarity
Principle of Common Good

 The principle of the common good, to which every aspect of social life must be
related if it is to attain its fullest meaning, stems from the dignity, unity, and
equality of all people.

 The common good does not consist in the simple sum of the goods of each subject
of a social entity. Belonging to everyone and to each person, it is and remains
“common”, because it is indivisible and because only together is it possible to attain
it, increase it and safeguard its effectiveness, with regard also to the future.
 A society that wishes and intends to remain at the service of the human being at
every level is a society that has the common good — the good of all people and of
the whole person — as its primary goal. The human person cannot find fulfillment in
himself, that is, apart from the fact that he exists “with” others and “for” others.
Responsibility of everyone for the common good

 The common good therefore involves all members of society, no one is exempt
from cooperating, according to each one's possibilities, in attaining it and
developing it

 Everyone also has the right to enjoy the conditions of social life that are brought
about by the quest for the common good.
Tasks of the political community

 The responsibility for attaining the common good, besides falling to individual
persons, belongs also to the State, since the common good is the reason that the
political authority exists.

 To ensure the common good, the government of each country has the specific duty
to harmonize the different sectoral interests with the requirements of justice.

 The common good of society is not an end in itself; it has value only in reference to
attaining the ultimate ends of the person and the universal common good of the
whole of creation.
Principle of Subsidiarity

 A social principle that calls on people to collaborate with each other in various kinds
of social groupings to accomplish differing common goods, from direct and
immediate to broad and complex one, and directed to a higher common good.

 A kind of sociological discipline adhered to and advocated by the church. Its moral
implication is embedded in its meaning.

 Means that what an individual, lower or smaller group can achieve within his/her or
its capacity should not be taken away and transmitted to the custody and
performance of a higher or bigger group.
Principles of Bioethics
Principle of Stewardship and Role of Nurses as
Stewards

 STEWARDSHIP refers to the expression of one’s responsibility to take care of,

nurture and cultivate what has been entrusted to him.

 In health care practice, STEWARDSHIP refers to the execution of responsibility of

the health care practitioners to look after, provide necessary health care services,
and promote the health and life of those entrusted to their care.
Roles of Nurses as Stewards

 Practice of bearing witness or being present to clients.

 Preserve and promote what is intrinsically valuable within their environments

 Recognize openness to clients by respecting their capacity to be authentic.

 Assist clients to express their feelings.

 Encourage clients to gain insight into their needs and their potential satisfaction.

 Participate in setting visions for health-care organizations that promote the greater
good.
Principle of Totality and its Integrity

 These principles dictates that the well-being of the whole person must be
considered in deciding about any therapeutic intervention or use of technology.

 A part exists for the good of the whole and may be sacrificed when necessary to
serve a proportionate good for the whole.
 INTEGRITY refers to everyone's duty to “preserve a view of the whole human
person in which the values of the intellect, will, conscience and fraternity are pre-
eminent”

 Integrity Types
 Anatomical integrity
 Functional integrity

 TOTALITY refers to the duty to preserve intact the physical component of the
integrated bodily and spiritual nature of human life, whereby every part of the
human body “exists for the sake of the whole as the imperfect for the sake of the
perfect”.
Anatomical vs Functional integrity

 Anatomical integrity
 Refers to the material or physical integrity of the human body.

 Functional integrity
 Refers to the systematic efficiency of the human body.
Organ Transplant

 Transplanting organs from one living person to another is ethically acceptable

provided that the following criteria are met:

1. There is a serious need on the part of the recipient that cannot be fulfilled in any
other way.

2. The functional integrity of the donor as a human person will not be impaired, even
though anatomical integrity may suffer.

3. The risk taken by the donor as an act of charity is proportionate to the good
resulting for the recipient.

4. The donor’s and the recipient’s consents are free and informed.
Principles of Ordinary and Extraordinary Means

Ordinary Means Extraordinary Means

 ‘usual’ or ‘customary’ for physicians to  ‘unusual’ or ‘uncustomary’ for physicians
use them for certain diseases, such as to use them for certain diseases or
pneumonia, or certain problems, such as problems.
malnutrition.
Principle of Personalized Sexuality

 Based on an understanding of sexuality as one of the basic traits of a person and

must be developed in ways consistent with enhancing human dignity.

 Takes note of a humanized sexuality, one that represents the fulfillment of physical
and sensual need but also evidenced with love and sacramental mystery.
 The principle of personalized sexuality may be stated as follows:
 The gift of human sexuality must be used in marriage in keeping with its intrinsic,
indivisible, specifically human teleology. It should be loving, bodily, pleasurable
expression of the complimentary, permanent self-giving of a man and woman to each
other, which is open to fruition in perpetuation and expansion of this personal
communion through the family they beget and educate.