The Doctrine of ‘Double Effect’

 

Helping to relieve patient pain and suffering is a crucial aspect of medicine, especially in hospice and palliative care. It is morally permissible in some situations and cases for physicians to take an action, for example administering a pain-reliving drug, that they are aware might result in the death of the patient. Although this type of act is not defined as intentional killing, the difficult question is how clinicians can do this ethically.

 

Moral justifications for actions that may result in the death of the patient include:

 

The physician does not intend by his or her action to cause the patient’s death. But intends only good effects.

 

Question

Physicians have different beliefs about how much pain ought to be relieved. They differ in their ideas of how pain should be relieved. Uncertainty and different risk-benefit judgements also result in different decisions about pain management.

 

Is the physician doing something wrong when they know that the patient’s death will result?

 

The duty of beneficence requires the physician do good. The act of administering a drug that may relieve symptoms or ease the suffering of the patient, thereby, making the patient’s remaining life more comfortable and possibly meaningful is a morally good act even thought it may also have bad effects.

 

Utilitarian theory would judge the rightness or wrongness of he action on the basis of their consequences. For example reducing the suffering of someone who was going to die anyway.

 

Question

Prevention of continuance of the inevitable process of dying is a humane medical act that is part of the moral responsibility of the physician-patient relationship.

 

Discuss.

 

Not all physician and ethicists agree that the so-called ‘double effect’ is an acceptable moral standard when the physician performing the act knows that death will result.

 

Question

There is a legal and technical difference between active euthanasia and passive euthanasia (withdrawing or withholding treatment). Is there a morally relevant distinction between killing and allowing to die or are they moral equivalents?

 

If there is a distinction, how should it be made?

 

Some philosophers have described the doctrine of ‘double effect’ as little more than a defensive rhetoric that allows clinicians to intervene in suffering and shorten life while superficially appearing to defend the sanctity of life principle.  

 

Question

Have patients you have treated understood the actions involving the withdrawal of treatment as ‘active termination of life’?