Ariston, Krisha Mae Gerra BSN-2A

The Principle of Double Effect

We all have these choices which we usually have trouble deciding with, probably
because those choices are not equally good, or the consequence might cause harm. This is
usually where the principle of double effect takes on how we are going to decide. To illustrate
this principle, imagine a patient who was in a car accident. He has been comatose for about a
year now. He has been declared brain dead and the family, who is currently in a financial crisis,
are now asking to pull the plug. The family though, doesn’t want to pull it and insist that you,
the nurse, should do it. Now, is it ethical to pull the plug?

As a nurse you are always taught to preserve the patient’s life, but in this case,
the family agreed on the euthanasia for the patient, since the patient can’t give consent, it is
the family who can. Think of the act you are about to make. Can it be labelled as a double effect?
Using a set of criteria, we can help label if euthanasia can be permissible. 1) The nature of the
act is good and morally neutral; is the nature of the act good? Maybe, one, because it stops the
patient’s suffering once and for all. Two, his family who’s in a financial crisis, can now be
relieved from paying continuous hospital bills. 2) The person doing the act intends the good
effect and not the bad effect; the act done intends to have a good effect. Even if the patient
have died by pulling the plugs from his life-support, it helped in taking out some burden on the
family and as well as the suffering of the patient, who might not even wake up anymore from
being brain dead. 3) The good effect outweighs the bad effect in situations that are serious that
can justify the bad effect or the person doing the act did it to prevent some more harm to
happen. It’s the same reason as the second criteria. It is to relieve the burden of both the family
and the patient.

Thomas Acquinas established the Principle of Double Effect by which states that an act
is permissible even though it has a bad effect as long as it is not intentionally done, or the intent
of doing the act is to produce something good an even if it had cause something bad. Acquinas
mentioned in Summa Theologica that homicidal self-defense can be a permissible act. He
justified that killing the attacker is allowed if the act is unintentional, stating that “this act, since
one’s intention is to save one’s own life, is not unlawful, seeing that it is natural to keep itself in
being as far as possible,” but also mentioned that the act is not unconditional, “thought
proceeding from a good intention, an can may be rendered unlawful if it be out of proportion
to the end. Wherefore, if a man in self-defense uses more than necessary violence, it will be
unlawful, whereas, if he repels force with moderation, his defense will be lawful.”

After all, this principle will help us in deciding on what action to take during a moral
dilemma that can happen in our life.
The Principle of Common Good and Subsidiarity

"Whatever helps us reach the Common Good, because it's in the nature of that specific
society to have such a responsibility.” Common good refers as to a standard of moral values
that is the most ideal. We follow this principle to know what the best option in making
decisions is. It helps us analyse problems with an optimistic point of view since we are actually
looking for a common goal that will benefit each one of us. For example, 10 families need a
school, but none of them is rich enough to build one, and they all want the school to be in their
back yard. Some "superior society" has to collect money from all those families, buy some land,
build a school and administer it. It could be an association founded by those 10 families, but it
must be something "above" them, and something "one", that is not as divided as those families.
Another example is if suppose there are 10 oil refineries in a country and 9 of them decide to
make investments to reduce pollution. This means their prices will rise. If one refinery decides
to just pollute the atmosphere and keep its prices low, it will be able to put the 9 other
refineries out of business, while simultaneously destroying everybody's health. If some
"superior society" has the authority to punish refineries that don't comply, they will all have to
decrease pollution and increase their prices, so none of them will lose any business (and we will
all breath cleaner air!). In situations like this we all actually need to find common ground or
common goal. If one cannot decide on how to resolve a problem, we all resort to solidarity
which helps us search for a choice that we can contribute on and will also benefit for everyone
who contributed for it. This principle also helps us balance situations that will have the same
treatment for everyone who are involved.

Subsidiarity is actually giving power to the minority. It guarantees independence for

lower authority which is in relation to a higher authority. One simple example is a parent letting
his kid decides what to wear to a party. It shows that the parent is giving the child the freedom
to choose. In a health care setting, subsidiarity can happen too. For example, a doctor (which is
considered as a higher authority) prescribed a drug to a patient but the nurse (the lower
authority) knew that it can actually have effects on the patient since the nurse learned that the
patient had allergies on the specific medication the doctor prescribed. So the nurse did not give
it to the patient. The nurse showed that she can also decide on her own. She might have
discarded the medication and also informed the doctor about it. Since the nurse has her own
knowledge, she is also capable of knowing what is good or bad for the patient. It doesn’t
necessarily need to follow the doctor’s orders immediately when given.
The Principle of Legitimate Cooperation

There are two types of cooperation that differentiates the action of the assailant from
the action of the co-operator through two major distinctions. The first distinction is the formal
and material cooperation which is when the co-operator intends in helping the act of the
assailant then the cooperation is formal of course morally wrong but if it is unintentional then
the cooperation is material. In a health care setting, usually Doctors and Nurses help hand in
hand with each other. What if the doctor plotted a crime to a patient just because he had a
grudge against that patient and so he asked for the nurse to do inject high dose of potassium to
the patient’s IV to be killed, then, it is formal cooperation if the nurse did it with the intention,
but if the doctor did prescribed that kind of those without telling the nurse the intent and the
nurse was oblivious and naïve and still gave the medication without the intention of actually
killing the patient is material cooperation.

Cooperation may be similar with partnership; accordingly there are three principles to
evaluate partnership. One is that the cooperation should be mediate material never formal or
immediate material. Second is in a partnership, you must agree that the decisions that you are
going to do together is actually appropriate. Cooperation with appropriate acts can eventually
help in the society. Lastly, everything should be straightforward. The partnership must be open
and must be honest. It shouldn’t contain any malice and doing anything behind the back.

References:

Aquinas, Thomas (13th c). Summa Theologica II-II, Q. 64, art. 7, “Of Killing”, in On Law, Morality,
and Politics, William P. Baumgarth and Richard J. Regan, S.J. (eds.), Indianapolis/Cambridge:
Hackett Publishing Co., 1988, pp. 226–7.

Retrieved from: https://plato.stanford.edu/entries/double-effect/

https://www.chausa.org/publications/health-progress/article/april-1995/the-principle-of-
cooperation

https://www.consciencelaws.org/religion/religion002.aspx

http://inquisition.ca/en/polit/artic/solidarite.htm