Principle of double

effect

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, and some
others, have advocated for evaluating the
permissibility of acting when one's
otherwise legitimate act (for example,
relieving a terminally ill patient's pain) may
also cause an effect one would otherwise
be obliged to avoid (sedation and a slightly
shortened life). The first known example of
double-effect reasoning is Thomas
Aquinas' treatment of homicidal self-
defense, in his work Summa Theologica.[1]

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.[2]

Intentional harm versus 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 his motive. So, for example, the
principle is invoked to consider the terror
bombing of non-combatants having as its
goal victory in a legitimate war morally out
of bounds, 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 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:

1. The nature-of-the-act condition. The

action must be either morally good or
indifferent.
2. The means-end condition. The bad
effect must not be the means by which
one achieves the good effect.
3. 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.
4. The proportionality condition. The bad
effect must not be disproportionate to the
good effect.

The second of these four conditions is an

application of the more general principle
that good ends do not justify evil means.[3]

Examples
Medicine

The principle of double effect is frequently

cited in cases of pregnancy and abortion.
A doctor who believes abortion is always
morally wrong may still remove the uterus
or fallopian tubes of a pregnant woman,
knowing the procedure will cause the
death of the embryo or fetus, in cases in
which the woman is certain to die without
the procedure (examples cited include
aggressive uterine cancer and ectopic
pregnancy). 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.[4][5][6]

In cases of terminally ill patients who

would hasten their deaths because of
unbearable pain, or whose caregivers
would do so for them (euthanasia, 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 the pain suffered is
considered harmful to the patient. The U.S.
Supreme Court has voiced support for this
principle in its deliberations over the
constitutionality of medical aid in dying.[7]

Criticisms
Consequentialists, 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, a
nineteenth-century advocate of the
utilitarian 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.[8] 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 – a moral dilemma
exploring the principle of double effect
Competing harms and necessity –
similar theories in civil law
Lesser of two evils principle

References
1. Summa Theologiae, IIa-IIae Q. 64, art. 7
2. T. A. Cavanaugh, Double-Effect
Reasoning: Doing Good and Avoiding Evil,
p.36, Oxford: Clarendon Press
3. Mark Timmons, Moral Theory: An
Introduction (Rowman & Littlefield 2003
ISBN 978-0-8476-9768-7), p. 80
4. McIntyre, Alison. "Doctrine of Double
Effect" . In Edward N. Zalta. Stanford
Encyclopedia of Philosophy (Summer
2006 ed.). Retrieved 2007-08-18.
5. "Principle of Double Effect" . Catholics
United for the Faith. 2003. Archived from
the original on 2007-09-27. Retrieved
2007-08-18.
6. Delgado, George. "Pro-Life Open Forum,
Apr 10, 2013 (49min40s)" . Catholic
answers. Archived from the original on 2
April 2015. Retrieved 2 September 2014.
7. Vacco v. Quill and Washington v.
Glucksberg, 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, 2004). The Court
made it clear that a “medical death”
hastened by palliative measures was
permissible.
8. John Stuart Mill, Utilitarianism (London:
Parker, Son and Bourn, 1863), page 26.

External links
Stanford Encyclopedia of Philosophy
entry
PhilPapers Bibliography: 'Doctrine of
Double Effect'
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