THE PRINCIPLEDOUBLE EFFECT

What is double effect?

According to Plato double effect says sometimes it is permissible to cause a harm as an

unintended and merely foreseen side effect of bringing about a good result even though it
would not be permissible to cause such a harm as a means to bringing about the same good
end.1

The principle of double effect was developed by Thomas Aquinas who formulated a concept
whereby it is morally acceptable to cause or permit evil in the pursuit of doing good. Double
effect usually arose in cases of dying patients arguing that provided it can be proved that the
doctor administered the pain-killer drugs primarily to relieve the patient suffering and not to
cause that patient’s death blameless. It was gradually refined over the centuries in order to
meet the unfortunate but very real moral dilemmas in which, no matter what is reasonably
done, one or more innocent human beings may be harmed or even die in the process of
resolving the dilemma.

Simply, we can say that the doctrine of double effect is a method for determining if you can
act in a situation where the side effects of your action are both positive and negative. There
are several different formulations of this doctrine, but most simply, you may take an action
which would produce both a good and a bad effect, if:

1. The situation is sufficiently serious

2. Your intent is to produce the good effect
3. The bad effect is not the way that the good effect is produced, and
4. The act is not inherently wrong.

The doctrine of double effect is based on the two principles, (Beneficence and Non-
maleficence) which is based on the principle of “above all, do not harm” and these two
principles are probably the essence of what people come to expect of doctrines. However,
there may be cases when one highly has to perform an action which may lead to a negative
outcome. Though this is the result of doing something which is prima-facie good like
prescribing painkiller to someone in divine pain but which, either because of the need to
increase the dosage or because of the patient’s condition, it leads to a bad result which is
thought to be premature death.

In the case of Airdalale NHS v Bland 19932, Bland was left in a vegetative state after the
disaster that he was involved in. He was kept on alive by life support machines and required
feeding via a tube. The doctors that were treating him were granted approval to remove the
tube that was feeding him. This decision was then appealed to the House of Lords. The issue
was whether the continuation of Bland being on life support was in his best interests. Lord
Golf said that the doctor is entitled to relieve pain and suffering even if the measures he takes

1
www.Plato.standford.edu
2
Airdlale NHS v Bland 1993
may incidentally shorten life. Because there was no potential for improvement, the treatmen.t
Bland was receiving was deemed not to be in his interests. The appeal was dismissed.

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 such application will be to abbreviate the patient’s life. Such a decision
may probably be made as part of the care of the living patient in his best interest and on this
basis the treatment will be lawful.

The conclusion of the double effect principle drawn is that the responsibility one bears for an
end is greater than the responsibility one bears for a foreseen side effect even though both are
serious considerations for the moral agent.

According to the catholic church the four formulations of the principle of double effects are:

Direct effect: The act itself produces a positive results or results without requiring any
additional positive action on the part of the person performing it.

Indirect Effect: The act produces positive result or results which would not have been
achieved without the act.

Foreseen side effects: The act produces negative side effects that would not have occurred
without the act in question but there is no certainty that this side effect will occur and it can
be calculated with reasonable certainty that this side effects will not happen.

Unforeseen Unintended side effects: The act needs to produce a significantly good effect to
sufficiently compensate for allowing the negative side effect.3

We can thus say that The doctrine of double effect offers some insight into the mindsets and
decision making processes people go through when dealing with difficult moral dilemmas.
The doctrine of double effect is also known as the law of intended consequences.

Thomas Acquinas summarizes the advantages and disadvantages of double effect as thus:

Advantages:

 It is realistic (Solving the problem of when two moral goods conflict).

Applying this to euthanasia which is the practice of ending the life of a patient to
limit the patient’s suffering, I cannot always relieve suffering and preserve life-
sometimes I risk end of life euthanasia in my attempts to reduce the pain a patient
suffers.
 It is proportional and so introduces flexibility and judgement (the means must be
proportional to the good end) – If I am administering a pain relieving drug I cannot

3
www.study.co/ThedoctrineofDoubleEffect
 overdose the patient without risking a murder charge. I can only give them the amount
of the drug necessary for the good end of the pain relief.
 It is teleological (it focuses on the good end and so reduces the moral status of the
undesirable means). Applied to euthanasia this means the good results must be
achieved independently if the drug is administered by a doctor and relieves the
patient’s pain by killing him, the doctrine of double effect can’t apply.

Disadvantages

 We are responsible for all the anticipated consequences of our actions: if we can
foresee the two effects of our action we have to take the moral responsibility for both
effects – we can’t get out of trouble by deciding to intend only the effect that suits us.
 Intention is irrelevant: some people take the view that it’s sloppy morality to decide
the rightness or wrongness of an act by looking at the intention of the doctor. They
think that some acts are objectively right or wrong, and that the intention of the person
who does them is irrelevant. But most legal systems regard the intention of the person
as a vital element in deciding whether they have commited a crime, and how serious a
crime is, in cases of causing death.
 Death is not always bad: So double effect is irrelevant. Other philosophers say that
the doctrine of Double Effect assumes that we think that death is always bad. They
say that if continued life holds nothing for the patient but the negative things of pain
and suffering, then death is a good thing, and we don’t need to use the doctrine of
double effect.
 Double effect can produce an unexpected moral result: If you do think that a
quicker death is better than a slower one then the doctrine of double effect shows that
a doctor who intended to kill the patient is morally superior to a doctor who merely
intended to relieve the pain.

CASES
1. The Malta twins. In Britain 2000, two conjoined girls, named Jodie and Mary in the
press, were born to a Roman Catholic couple from Malta. The couple had come to
Britain after learning that they were expecting conjoined twins. It became apparent to
doctors that Mary was exerting a major drain on Jodie: It was Jodie’s heart and lungs
that were responsible for providing oxygenated blood to Mary. The twins’ doctors
recommended to the parents that surgery be performed in order to separate the twins.
The rationale for this was that both twins would soon die were this surgery not
performed; however, the performance on the surgery would, while saving Josie’s life,
inevitably bring about Mary’s death.

The parents objected, largely though not entirely, on grounds that the surgery would
involve the intentional killing of Mary, and the doctors took the case to British court.
The parents were supported in their decision by Archbishop Murphy-O’Connor, who
 argued, with the parents, that the surgery would involve “the killing of, or a deliberate
lethal assault on, one of the twins, ‘Mary’ in order to save the other, ‘Jodie.’”
The Archbishop acknowledged the possibility that the death could be thought to be
outside the intention. However, he argued that even if this was the case, the surgery
would nevertheless be an intentional invasion of Mary’s bodily integrity. Murphy-
O’Connor thus held that the “separation cannot be thought of with any plausibility as
one of cutting into Jodie’s body alone; Mary’s body is necessarily cut into. That
violation of her bodily integrity is in the nature of the case lethal for her. It therefore
cannot be justified.”

Now turning to the question of double effect, was the death of Mary intended?
It seems the answer to this is in the negative. A great strain was being placed
on Jodie’s heart and lungs, to the point that if that strain was not relieved, she
would die. There is nowhere in this proposal is there any practical adoption of
the death of Mary as a part of what was chosen in order to bring about either
the relief from the strain, or the detachment from Jodie. Death played no role
in the proposal, save as an unwilled, and certainly regretted, side effect: one
whose gravity would certainly have justified refraining from surgery, were it
not for the inevitability of that side effect regardless of what was done. The
essential thing here is that, from the agent’s standpoint, what is seen as
necessary for the attainment of the end, saving Jodie’s life, was simply that
she be physically detached from her sister, not that her sister be killed.4

Criticisms
Critics of the doctrine of double effect argue that is oversimplifies the intentions of an
action. I t also ignores other factors such as means and proportionality.
Thomas Aquinas argued that there are other reasons for performing actions besides
producing their intended effects and that intentions must be taken into
consideration in assessing whether or not a valid action complies with the
moral law.5
Critics of the use of double effects as an explanatory principle point out that the
proportionality condition is vague and too general, requiring only that the
good effect outweigh the foreseen bad effect or that there be sufficient reason
for causing the bad effect.6

4
https:/www.academia.edu/14945026/Double_Effect_and_Two_Hard_Cases_in_Medical_Ethics

5
www.study.com/Criticismsofthedoctrineofdoubleeffect

6
www.plato.standford.edu