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Double Effect and the Ethical Dilemma

(This post is by Chris Smith and is the next post in the series on Philosophy and Theology that the ThM students are engaged in.)

The article that I have chosen to post about is “The Rule of Double Effect—A Critique of Its Role in End-of–Life Decision Making” by Timothy E. Quill. This is how I understand the double effect rule: The double effect rule states that a doctor is ethically justified in prescribing medicine that is intended to treat a terminally ill patient’s pain even if this same medicine may decrease the patient’s expected lifespan or result in death. The double effect rule justifies a doctor’s actions based on the nature of their intentions. If a doctor prescribes medicine with the intention of minimizing pain but causes a patient’s death, his actions are justified under the double-effect rule; however, if a doctor prescribes medicine with the intention of causing death, his actions are not justified. (The assumption behind this rule is that there is not a less harmful drug available to treat the kind of pain the patient is experiencing.) The rule is called double effect because a doctor’s intention can have two effects: the intended relief of pain and foreseen but unintended death.
The double effect rule begs the question: Can the desire to alleviate extreme and terminal pain ever outweigh a doctor’s imperative to preserve physical life? Quill states: “The word ‘intentional’ suggests, however, that the deaths of innocent persons may be permissible if brought about unintentionally” (1768).  Here we need to understand the meaning of unintentional not as an accidental effect that is unexpected but as a potential effect that is not intended. When a doctor seeks to alleviate pain by increasing dosages that will have a harmful effect on the patient, can he really by justified when he knows that his actions are further contributing to the patient’s inevitable death? I would say he is justified in this act because his intention is to alleviate.

A case Quill describes makes the double effect rule even more reasonable in my opinion. He describes a patient who is on a respirator in order to help him breath. Is a doctor justified in his decision to turn off a respirator in hopes that the patient will be able to breathe without it? I would say the act of turning off the machine is justified even if the patient dies because the hope was to draw on the patient’s strength to stimulate his own breathing. The patient’s death may have been possible (“foreseen”) but unintentional because the desire was to see the patient breathe on his own. I find this to be a more effective use of the double effect rule because the doctor was attempting to stimulate the patient to greater health rather than attempting to prevent pain.