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The Pope, condoms, and the principle of double effect

While I was at ETS, some of our ThM students were discussing theological ethics and the principle of double effect (PDE), a way of thinking through complex moral situations in which a single act has both a negative and a positive consequence. (See Chris Smith’s post on Double Effect and the Ethical Dilemma.) Since I was not able to participate in the discussion, and since I don’t want to look stupid in front of my students, I thought it would be a good idea for me to work on my own understanding of this principle. So, it was with interest that I dug into a recent post by Katie over at the Women in Theology, arguing that the Pope’s recent statements about condom use can be analyzed using PDE.

By now, you’ve probably heard about the upcoming book in which Pope Benedict XVI apparently condones the use of condoms in certain situations, particularly when used to prevent the spread of HIV/AIDS among prostitutes. At first glance, this seems rather surprising given that for Catholic theologians, condom use necessarily results in the bad effect of separating the the sexual act from its unitive and procreative act. Although this is an unpopular position in modern culture, this view underlies the traditional Catholic rejection of contraception in general. But, as the Pope has pointed out, condom use also has the intrinsically good effect of preventing the spread of a deadly disease. Thus, we have a situation in which a single act (condom use) will result in both a good effect (preventing disease spread) and a bad effect (separating the sexual act from its divinely intended purposes).

To determine whether PDE applies to this scenario, we must see if the scenario meets the following conditions:

  1. The Nature of the Act: The act in question must be at least a morally neutral act (i.e. it cannot be an intrinsically bad act).
  2. Means-End: The bad effect  cannot be the means by which the good effect is accomplished.
  3. Right-Intention: The bad effect cannot be that which is intended by the actor.
  4. Proportionality: The good effect must be equivalent to or greater than the corresponding bad effect.

And, as I see it, the condom-use scenario meets all four conditions.

  1. The Nature of the Act: It seems to me that even for Catholic theologians, condom use is a morally neutral act. In and of itself, using a condom has no moral consequences (e.g. using it as a water balloon). It is one  particular result of using a condom (preventing conception and, consequently, separating the sexual act from its procreative function) that is instrinsically wrong.
  2. Means-End: As in most PDE scenarios the good effect and bad effect are inseparable. Wearing a condom during the sexual act (assuming that the condom does not malfunction) necessarily results in both consequences. But, it seems clear that the bad effect in this situation is not the means for accomplishing the good effect – i.e., a person does not seek to separate the sexual act from its intended purposes as a means to preventing the spread of a deadly disease. The two consequences are inseparable, but the one is not the means for accomplishing the other.
  3. Right-Intention: This is critical. For this situation to come under PDE, the actor must intend the good effect and not the bad one. So, in this scenario, the person using the condom must intend to stop the spread of a deadly disease and not to prevent procreation.
  4. Proportionality: The benefit of preventing the spread of a deadly disease must outweigh the drawback of separating the sexual act from its procreative function. As with most PDE scenarios, there is a strong element of subjectivity in this final step. But, it is certainly not obvious that this scenario violates this condition.

So, it would seem to me that this scenario is amenable to analysis using PDE. And, the Pope’s conclusion seems warranted, assuming that you agree with the application of condition 4 and the use of PDE in general.

That is my best attempt to explain how PDE works and how it applies to a situation that most Protestants would not necessarily see as involving a significant moral quandry. But, it demonstrates how PDE might be applied to other scenarios with more existential angst for us. And, it also highlights some of the weaknesses of the approach: the often opaque appeal to intentions, an ambiguous understanding of what qualifies as an “act”, and the necessarily subjective judgment required by the proportionality condition. At the same time, though, I like the way that PDE forces us to acknowledge how difficult it can be to make moral judgments in the midst of a broken world in which sometimes there are no “right” answers.

    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.