What does doctrine of double effect mean

The doctrine of double effect This doctrine says that if doing something morally good has a morally bad side-effect it's ethically OK to do it providing the bad side-effect wasn't intended. Factors involved in the doctrine of double effect The good result must be achieved independently of the bad one: For the doctrine to apply, the bad result must not be the means of achieving the good one.

So if the only way the drug relieves the patient's pain is by killing him, the doctrine of double effect doesn't apply. The action must be proportional to the cause: If I give a patient a dose of drugs so large that it is certain to kill them, and that is also far greater than the dose needed to control their pain, I can't use the Doctrine of Double Effect to say that what I did was right.

The action must be appropriate a : I also have to give the patient the right medicine. If I give the patient a fatal dose of pain-killing drugs, it's no use saying that my intention was to relieve their symptoms of vomiting if the drug doesn't have any effect on vomiting. The action must be appropriate b : I also have to give the patient the right medicine for their symptoms. If I give the patient a fatal dose of pain-killing drugs, it's no use saying that my intention was to relieve their symptoms of pain if the patient wasn't suffering from pain but from breathlessness.

The patient must be in a terminal condition: If I give the patient a fatal dose of pain-killing drugs and they would have recovered from their disease or injury if I hadn't given them the drugs, it's no use saying that my intention was to relieve their pain. And that applies even if there was no other way of controlling their pain. Problems with the doctrine of double effect Some philosophers think this argument is too clever for its own good.

We are responsible for all the anticipated consequences of our actions: If we can foresee the two effects of our action we have to take the moral responsibility for both effects - we can't get out of trouble by deciding to intend only the effect that suits us. Intention is irrelevant: Some people take the view that it's sloppy morality to decide the rightness or wrongness of an act by looking at the intention of the doctor.

They think that some acts are objectively right or wrong, and that the intention of the person who does them is irrelevant. If these arguments are correct, then they cast doubt on the claim that Double Effect explains the permissibility of these actions.

Double Effect is silent about cases in which it is permissible to cause a death as a means to a good end. Warren Quinn has argued that double effect does not rest on the distinction between intended and merely foreseen harm, but instead is best formulated using a distinction between direct and indirect agency see the Formulations section.

But perhaps this is as it should be: double effect might be easier to explain and justify if the range of cases to which it applies is limited in this way. Instead, independently grounded moral considerations have influenced how we draw the distinction between means and side effects in the first place. Empirical research by Joshua Knobe , has demonstrated that the ways in which we distinguish between results that are intended or brought about intentionally and those that are mere side effects may be influenced by normative judgments in such a way as to bias our descriptions.

Richard Holton has observed that norm violation merely involves knowingly violating a norm, while complying with a norm involves an intention to comply with it, and that this might explain the asymmetry Knobe has documented in judgments about whether bad and good results are brought about intentionally.

This discussion raises questions about the suitability of the distinction highlighted by the principle of double effect for serving as an evaluatively neutral basis for moral judgments. Does the principle of double effect explain the permissibility of switching a runaway trolley away from a track with five people on it and onto a track containing only one person? Of course, if the harm to the one is rightly described as a merely foreseen side effect of switching the trolley, then this alone does not show that it is permissible to cause it.

However, if the proportionality condition is satisfied, and if the agent attempts to minimize the harm or to identify alternative means of saving the five and fails, then these factors together might seem to imply that the principle of double effect can be invoked to explain the permissibility of switching the trolley.

Moreover, Double Effect seems to explain the impermissibility of pushing someone onto the track in front of the speeding trolley in order to stop it and protect the five on the track ahead. In both scenarios, a person would be killed as part of saving the five; the difference in permissibility seems to depend on whether the death of that person is a means or a side effect of saving them. Discussions of the Trolley Problem and the relevance of the principle of double effect to explaining our intuitions about it can be divided into three groups.

First, there are consequentialists who view the widespread reluctance people feel to push someone in the path of the trolley in order to stop it and save the five as irrational Joshua Greene, Second, there are those who take the paired intuitions in the Trolley Problem as proof of the fundamental role of Double Effect as an implicit principle guiding moral judgment Philippa Foot, , John Mikhail, This group would include those who uphold the principle of double effect but deny that it provides a permission to swerve the trolley Elizabeth Anscombe, and those who reject the principle of double effect while conceding that the standard intuitive judgments about the Trolley Problem comport with the principle as it ordinarily interpreted.

The contrast between the Terror Bomber and the Strategic Bomber is often viewed as the least controversial pair of examples illustrating the distinction between intention and foresight that underlies the principle of double effect.

The judgment that the Terror Bomber acts impermissibly and the Strategic Bomber acts permissibly is widely affirmed. Terror bombing was engaged in by both sides in World War II see Douglas Lackey for a thoughtful historical account of the decision process engaged in by Allied decision-makers and the controversy it generated at the time.

The view that terror bombing is always impermissible would condemn the kind of incendiary bombing carried out by Allied forces in Germany and Japan. The common judgment that strategic bombing is permissible provided that it is proportionate also deserves more scrutiny than it usually receives when it is taken to be justified by the principle of double effect. How much of an obligation do military strategists have to avoid harm to civilian populations?

This is a substantive issue about the conventions that constrain military decision-making and the principles that underlie these conventions. Many relevant considerations depend on judgments that are far outside the ambit of Double Effect. For example, the Rules of Customary International Humanitarian Law displayed on the website of the International Committee of the Red Cross prohibit attacks targeting civilians.

They also include protections denied to minimize harm to civilians:. Rule Precautions in Attack In the conduct of military operations, constant care must be taken to spare the civilian population, civilians and civilian objects.

All feasible precautions must be taken to avoid, and in any event to minimize, incidental loss of civilian life, injury to civilians and damage to civilian objects. Advance Warning Each party to the conflict must give effective advance warning of attacks which may affect the civilian population, unless circumstances do not permit.

Removal of Civilians and Civilian Objects from the Vicinity of Military Objectives Each party to the conflict must, to the extent feasible, remove civilian persons and objects under its control from the vicinity of military objectives. These considerations suggest that the principle of double effect does not contain, even when the principle of proportionality is included as part of its content, a sufficient condition of permissibility for bombardment that affects civilian populations.

The example concerning strategic bombing so frequently invoked by philosophers never mentions a duty to warn or remove civilians. It is not at all clear that all of the examples that double effect has been invoked to justify can be explained by a single principle. There may in fact be a variety of considerations that bear on the permissibility of causing unintended harm. Proponents of the principle of double effect have always acknowledged that a proportionality condition must be satisfied when double effect is applied, but this condition typically requires only that the good effect outweigh the foreseen bad effect or that there be sufficient reason for causing the bad effect.

Some critics of the principle of double effect have maintained that when double effect has been invoked, substantive independent justifications for causing the kind of harm in question are implicitly relied upon, and are in fact, doing all of the justificatory work.

These independent considerations are not derived from the distinction between intended and merely foreseen consequences and do not depend on it Davis , McIntyre If this criticism is correct, then perhaps the cases that have traditionally been cited as applications of the principle of double effect are united only by the fact that each is an exception to the general prohibition on causing the death of a human being.

The historical origins of the principle of double effect as a tenet of Catholic casuistry might provide a similar explanation for the unity of its applications. If one were to assume instead that what is absolutely prohibited is to cause the death of a human being intentionally, then these cases can be viewed as cases of non-intentional killing. Controversy about the principle of double effect concerns whether a unified justification for these cases of non-intentional killing can be provided and if so, whether that justification depends on the distinction between intended and merely foreseen consequences.

This way of characterizing harmful direct agency and harmful indirect agency could be thought of as two possible dimensions of agency in which harm is not intended, rather than as a contrast within a single dimension of agency. This view would be supported if it turns out that some complex plans of action count as both harmful direct agency and harmful indirect agency. For example, consider the deliberations of public health officials who propose to put in place a vaccination program in their region in order to protect citizens from a rapidly spreading, highly contagious, and invariably lethal disease.

They foresee that if the program is carried out, about one in ten thousand vaccine recipients will experience adverse effects from the vaccine that will prove fatal, and the officials have no way to identify in advance which vaccine recipients will be susceptible to these adverse effects in order to screen them and exclude them from receiving the vaccine.

It might seem that Double Effect is designed to explain why they may proceed with the vaccination program despite these foreseeable, regretted, and unpreventable unintended side effects of promoting a good end: this might seem to be a case of indirect agency. This would make their actions in promoting the program a case of direct agency. Issues about consent may be relevant here as well: if the vaccine recipients willingly assume the risk of experiencing adverse effects, then a full description of the program must consider their own agency in assessing the information they receive.

Examples like these suggest that the cases Double Effect has been taken to apply to may involve many different dimensions of agency rather than a sharp contrast that concerns a single dimension of agency. Critics of the principle of double effect claim that the pattern of justification used in these cases has some shared conditions: the agent acts in order to promote a good end, shows adequate respect for the value of human life in so acting, and has attempted to avoid or minimize the harm in question.

However, they maintain that the justification for causing the harm in question depends on further substantive considerations that are not derived from the contrast between intention and foresight or the contrast between direct and indirect agency. Scanlon The principle of double effect is often mentioned in discussions of what is known as palliative care, medical care for patients with terminal illness in need of pain relief.

Three assumptions often operate in the background of these discussions:. When these assumptions are made, double effect seems to provide at least part of a justification for administering drugs to relieve pain. Yet the first assumption is false. Physicians and researchers have insisted repeatedly that it is a myth that opioids administered for pain relief can be expected to hasten death Sykes and Thorns, provide a review of a large number of studies supporting this claim. There is no research that substantiates the claim that opioid drugs administered appropriately and carefully titrated are likely to depress respiration.

There is a broad consensus that when used appropriately, respiratory depression from opioid analgesics is a rarely occurring side effect. The belief that palliative care hastens death is counter to the experience of physicians with the most experience in this area. The appropriate conclusion, then, is that double effect plays no role whatsoever in justifying the use of opioid drugs for pain relief in the context of palliative care.

Why is double effect so frequently mentioned in discussions of pain relief in the context of palliative care if its application rests on and thereby perpetuates a medical myth? The popularity and intuitive appeal of this alleged illustration of double effect may have two sources.

Second, the myth that pain relief hastens death might have persisted and perpetuated itself because it expresses the compassionate thought behind the second assumption: that the hastening of death may be a welcome side effect of administering pain relief to patients at the end of life.

This point of view may not be consistent with invoking Double Effect as a justification: if, in the course of treating a dying patient, death is not viewed as a harm, then Double Effect does not apply see Allmark, Cobb, Liddle, and Todd Furthermore, the apparently compassionate assumption that the hastening of death is a welcome result may be unduly paternalistic in the context of end of life care in which the patient is not dying. Patients receiving palliative care whose pain can be adequately treated with opioid drugs may well value additional days, hours or minutes of life.

It is unjustified to assume that the hastening of death is itself a form of merciful relief for patients with terminal illnesses and not a regrettable side effect to be minimized. Recall that the most plausible formulations of double effect would require agents to seek to minimize or avoid the merely foreseen harms that they cause as side effects. Those who defend double effect often assume that their opponents deny that an agent's intentions, motives, and attitudes are important factors in determining the permissibility of a course of action.

If the permissibility of an action depended only on the consequences of the action, or only on the foreseen or foreseeable consequences of the action, then the distinction that grounds double effect would not have the moral significance claimed for it see the related entry on consequentialism.

Some opponents of double effect do indeed deny that the distinction between intended and merely foreseen consequences has moral significance. Yet many criticisms of double effect do not proceed from consequentialist assumptions or skepticism about the distinction between intended and merely foreseen consequences but instead ask whether the principle adequately codifies the moral intuitions at play in the cases that are taken to be illustrations of double effect.

Doubts about the explanatory value of double effect have often focused on the difficulty of distinguishing between harmful effects that are regretfully intended as part of the agent's means and harmful effects that are regretfully foreseen as side effects of the agent's means. Since double effect deems the former to be impermissibly brought about, while the latter may be permissible, those who wish to apply double effect must provide principled grounds for drawing this distinction.

For example, if the soldier who throws himself on the grenade in order to shield his fellow soldiers from the force of an explosion acts permissibly, and if the permissibility of his action is explained by double effect, then he must not intend to sacrifice his own life in order to save the others, he must merely foresee that his life will end as a side effect of his action. But many have argued that this is an implausible description of the soldier's action and that his action is permissible even if he does intend to cause his own death as a means to save the others.

Shelly Kagan points out that if someone else were to shove the soldier on the grenade we would certainly say that that the harm to the soldier was intended by the person who did the shoving.

Equally, Kagan argues, we should say that it is intended in this case p. The same kind of argument can be made for cases of killing in self-defense.

Those who take this view can claim that what is often called the proportionality condition associated with double effect is really doing all of the explanatory work: it is because the end is judged to be worthy that the harmful means is considered to be permissibly brought about.

Those who reject double effect for this reason may still maintain that there is a morally significant difference between self-sacrifice of this sort and suicide, but that the difference depends on a difference in the agent's motives and ends, not a difference in the means adopted. This kind of criticism about the explanatory reach of the principle of double effect might also be associated with the worry that we will be inclined to describe a harm as a merely foreseen side effect if we believe that it is permissibly brought about in the course of pursuing a good end, and, similarly, we will tend to describe a harm as one that is intended as part of the agent's means if we believe that it is not permissibly brought about in the course of pursuing a good end.

Disputes about the permissibility of killing a fetus in order to save the life of a pregnant woman have often been thought to take this form. Those who say that it would be impermissible to perform an abortion to save the life of a pregnant woman say that this is because this would involve intending the death of the fetus. However, if it is also maintained that a hysterectomy may be performed on a pregnant woman with uterine cancer because the death of the fetus would be a merely foreseen side effect of surgery, it is hard to find a principled ground for drawing this distinction that could serve as a guide to moral judgment.

Warren Quinn has argued that double effect does not rest on the distinction between intended and merely foreseen harm, but instead is best formulated using a distinction between direct and indirect agency see the Formulations section. Quinn's view would imply that typical cases of self-defense and self-sacrifice would count as cases of direct agency.

One clearly intends to involve the aggressor or oneself in something that furthers one's purpose precisely by way of his being so involved. Therefore, Quinn's account of the moral significance of the distinction between direct and indirect agency could not be invoked to explain why it might be permissible to kill in self-defense or to sacrifice one's own life to save the lives of others. But perhaps this is as it should be: double effect might be easier to explain and justify if the range of cases to which it applies is limited in this way.

If Quinn's view is correct, and if the distinction between direct and indirect agency is easier to draw clearly, and is not subject to redescription under the influence of our moral judgments about permissibility, then perhaps the objections outlined above can be answered. A second striking feature of Quinn's interpretation or revision of double effect is that it analyzes the disfavored kind of agency as conduct that subordinates the victim to purposes that he or she either rightfully rejects or cannot rightfully accept, thereby violating the victim's right not to be surbordinated in this way , p.

Equally harmful indirect agency would not violate this right, but it is violated, according to Quinn, only when other rights are violated. Therefore, its force is not entirely independent from the kind of wrong that is present in cases of indirect agency, since it amplifies this, but it is additional to it, and distinguishable Quinn , p. Thus, the harms brought about by fair competition, or in justifiable punishment do not violate any right of the persons affected, and so, on Quinn's view, do not violate this additional right even if they are brought about intentionally.

It is not at all clear that all of the examples that double effect has been invoked to justify can be explained by a single principle. Proponents of double effect have always acknowledged that a proportionality condition must be satisfied when double effect is applied, but this condition typically requires only that the good effect outweigh the foreseen bad effect or that there be sufficient reason for causing the bad effect.

Some critics of double effect have maintained that when double effect has been invoked, substantive independent justifications for causing the kind of harm in question are implicitly relied upon, and are in fact, doing all of the justificatory work.

These independent justifications are not derived from the distinction between intended and merely foreseen consequences, and more significantly, might presuppose different ways of drawing the distinction Davis, McIntyre.

Thus, self-sacrifice and killing in self-defense might involve permissibly causing death as a means to a good end, while dispensing medication to relieve pain in terminally ill patients and the strategic bombing of military targets might involve causing death as a side effect.

If this is true, then perhaps the cases that have been cited as applications of double effect are united only by the fact that each is an exception to the general rule that it is wrong to cause the death of a human being. The historical origins of double effect as a tenet of Catholic casuistry might provide a similar explanation for the unity of its applications.

If one were to assume that it is absolutely prohibited to cause the death of a human being, then it would not be permissible to kill an aggressor in self-defense, to sacrifice one's life to protect others, to hasten death as a side effect of administering pain-relieving medications, or to endanger non-combatants in warfare.

If one were to assume instead that what is absolutely prohibited is to cause the death of a human being intentionally, then these exceptional cases can all be classified as cases of non-intentional killing. Critics of double effect might then claim that a better way of explaining what these cases have in common is to point out that they are exceptions to the prohibition on causing the death of a human being, and that the pattern of justification that they share requires that the agent acts in order to promote a good end and shows adequate respect for the value of human life in so acting.

What the critics of double effect emphasize is that the distinction between what is intentional and what is foreseen does not explain the permissibility of these exceptions. Scanlon has recently developed this kind of criticism by arguing that the appeal of double effect is, fundamentally, illusory: an agent's intentions are not relevant to the permissibility of an action in the way that the proponents of the principle of double effect would claim, though an agent's intentions are relevant to moral assessments of the way in which the agent deliberated.

That an agent intended to bring about a certain harm does not explain why the action was impermissible, but it can explain what is morally faulty about the agent's reasoning in pursuing that line of action. The principle of double effect is often mentioned in discussions of what is known as palliative care, medical care for patients with terminal illness in need of pain relief. Three assumptions often operate in the background of these discussions:.