The double life of double effect

Theoretical Medicine and Bioethics

Volumn 25, Issue 1, 2004, Pages 61-74

  McIntyre, Allison ^a  

^a WELLESLEY COLLEGE   (United States)

Author keywords

Double effect; Incidental harming; Instrumental harming; Palliative care; Terminal sedation

Indexed keywords

ARTICLE; COURT; DEATH; HUMAN; LIFESPAN; MEDICAL ETHICS; MEDICAL PRACTICE; PALLIATIVE THERAPY; PHYSICIAN; SEDATION; UNITED STATES; ANALYTICAL APPROACH; DEATH AND EUTHANASIA; ETHICS; EUTHANASIA; INTRACTABLE PAIN; JURISPRUDENCE; LEGAL APPROACH; LEGAL ASPECT; TERMINAL CARE; VACCO V. QUILL;

HYPNOTIC SEDATIVE AGENT;

ANALYTICAL APPROACH; DEATH AND EUTHANASIA; LEGAL APPROACH; VACCO V. QUILL;

DOUBLE EFFECT; EUTHANASIA; HUMANS; HYPNOTICS AND SEDATIVES; PAIN, INTRACTABLE; PALLIATIVE CARE; SUPREME COURT DECISIONS; TERMINAL CARE; UNITED STATES;

EID: 3042676372     PISSN: 13867415     EISSN: None     Source Type: Journal    
DOI: 10.1023/B:META.0000025095.73394.34     Document Type: Article

References (27)

1. The Respondents were three physicians who practice in New York: Timothy E. Quill, Samuel C. Klagsbrun, and Howard A. Grossman, Vacco v. Quill Respondents' Brief, http://www.compassionindying.org/legal.cidbref1.html pp. 1-31, accessed August 23, 2003.
2. S. Ct. 793 (1997).
3. Vacco v. Quill Respondents' Brief, p. 1.
4. Vacco v. Quill Respondents' Brief, p. 1.
5. Vacco v. Quill Respondents' Brief, p. 1.
6. Vacco v. Quill Respondents' Brief, p. 3.
7. Vacco v. Quill Respondents' Brief, p. 3.
8. S. Ct. 793 (1997), p. 800.
9. S. Ct. 793 (1997), p. 801.
10. 521 S. Ct. 793 (1997), pp. 801-802, citation to testimony of Dr. Leon Kass omitted.
11. 521 S. Ct. 793 (1997), p. 802, citation to testimony of Dr. Leon Kass omitted.
12. 521 S. Ct. 793 (1997), p. 802.
13. 521 S. Ct. 793 (1997), pp. 802-803.
14. 521 S. Ct. 793 (1997), pp. 750-751.
15. 521 S. Ct. 793 (1997), p. 751.
16. 521 S. Ct. 793 (1997), p. 751.
17. 521 S. Ct. 793 (1997), n. 11, p. 807.
18. 521 S. Ct. 793 (1997), n. 12, p. 808.
19. 521 S. Ct. 793 (1997), pp. 791-792.
20. 521 S. Ct. 793 (1997), p. 792.
21. 521 S. Ct. 793 (1997), pp. 736-737.
22. 521 S. Ct. 793 (1997), p. 737.
23. Warren Quinn presents such a version of DE in "Actions, Intentions, and Consequences: The Doctrine of Double Effect," Philosophy & Public Affairs 18 (1989): 334-351, at 335.
24. St. Thomas Aquinas imposes this constraint on the justification for killing an assailant in self-defense: "an act 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" Summa Theologica II-II, qu. 64, art. 7, "Of Killing".
25. Traditionally, DE is cited to explain why terror bombing, which aims to kill civilians as a means of demoralizing and weakening the enemy in order to win the war is not justified, while strategic bombing, which also kills civilians, perhaps even the same number of civilians, but as a side effect of striking military targets may be justified. If the terror bomber could say: "I really intended only to demoralize the enemy and persuade them to surrender, if I could have brought that about without actually killing so many people I would have. I certainly would not have adopted alternative means to kill civilians if I had terrorized but failed to kill them" and if this were taken to be an application of DE, then DE would not only not prohibit his action, it would justify it!
26. This strange state of affairs, one in which DE is cited to justify practices that traditional versions of DE must condemn, is not restricted to debates about palliative care. There is a similar duality in the other traditional applications of DE. To many people, DE's supposed permissions have always seemed more plausible and compelling than DE's supposed prohibitions, and these prohibitions have always been hard to reconcile with what DE has supposedly permitted. Most egregious in this respect is the justification provided for actions like killing an assailant in self-defense and sacrificing one's life heroically to save others. These seem to be clear cases in which causing a morally grave effect as part of a means to a good end is permissible because the action causing the morally grave regretted effect is aimed at only instrumentally. I argue for this view at greater length in my "Doing Away with Double Effect," Ethics 111 (2001): 219-255.
27. Consider these candid reflections of a palliative care physician regarding a patient who moaned for seventeen hours after the initiation of terminal sedation "by following the established guidelines for pain and suffering medication titration, the end of life seemed to be inexorably and senselessly delayed." Mark J. Lema "Terminal Killing, Mercy Sedation," American Society of Anesthesiologists Newsletter 64, (2000) 8: 26, cf. 1.