The Doctrine of Double Effect
The principle of double effect also called the doctrine of double effect normally applied in the medicine, palliative care and war fields is always invoked in order to explain the permission to carry out an action that can cause serious harm. The harm in this case may include the death in human beings as a result of the side effects otherwise with the aim of promoting some good. This doctrine affirms that at times it may be permissible to cause harm as side effect to arrive at a desirable result. However it becomes necessary to understand that it is not permissible to cause such harm so as to arrive at the same good end
Thomas Aquinas coined this principle during his discussion of the permissibility of self defense. Aquinas observed that nothing hinders one act from having two effects only one of which is intended whereas the other is besides the intention.
There are four conditions tied to the application of this principle:
The act must be morally good or else indifferent. In other words the good result should be achievable apart from the bad one
The good effect must be derived from the action immediately just as the bad effect. This implies that the desirable or good effect is produced directly by the action not by the bad effect.
The good effect should be proved sufficiently desirable as compensation for allowing the bad effect
The agent who in this case may be the practitioner of the principle should not positively will the bad effect but may permit it. In other words the bad effect here is considered as an indirectly voluntary happening.
Administering a vaccine for example will definitely save many lives. However a few people get sick and even die from the vaccine’s side effects. The vaccine manufacturer and agent who administer the vaccine are morally discharged. This is because lives are saved because of the vaccination and not as a result of the fatalities resulting from the side effects. The fatalities as a result of the vaccine do not advance any objectives of the agents and therefore is not intended as a means to an end. The number of lives saved by the vaccine is much greater than the numbers who die from the side effects satisfying the proportionality condition legitimizing this principle.
In order to understand if this principle provides a sound basis to make a distinction between intentional and unintentional actions for which we are morally responsible or not we need to summarize the conditions under which the principle of double effect would be considered ethically legitimate and these are that:
The act being performed is not itself morally evil. Using the vaccine example we can point out that the manufacturers or administrators of the same (agents) are not performing a morally evil act.
The good effect in this case of the vaccine example is to save lives and is not as a result of the evil effect the fatalities resulting from the vaccine’s side effects.
Only the good effects in this case the saving of lives through body immunity enhancement by the vaccine is directly intended, the bad effects which would be the death due to side effects of the vaccine is not intended but tolerated or unavoidable.
There is due proportion between good which is the total number of people who benefit by boosting their immunity through the vaccine and the bad effects which is the small proportion of people who succumb to the vaccine’s side effects.
Considering palliative care and medical cases this principle provides a sound basis for making a distinction. According to Dr. Taboada we have to understand that a moral act does not merely consist of a physical performance. There is the moral species of the act that we must consider as well. The moral species of the act can be analyzed by asking the question what are you doing? An appropriate answer that can be backed by this principle of double effect would reveal an intrinsic intentionality of the moral act. Using the case of palliative care where an agent such as a doctor uses morphine to relieve pain in terminally ill patients to elaborate this fact we would have a more accurate answer to the moral species act question what are you doing ? as relieving pain. This answer reveals the intrinsic intentionality of the moral act.
Dr. Taboada further points out that ethical experiences are determined by the moral species of the act which in essence is the kind of act we perform.
There can be proved a relationship between an agent’s motivation and the moral character of the given action. Therefore the intrinsic intentionality of the act itself and the intention of the agent are not the same thing as elaborated by Dr. Taboada and hence they must be carefully distinguished.
Further still ethical character of our actions do not primarily depend on motivation or intention of the agent as such but on the moral species of the action performed.
Thus the principle of double effect intends to secure this distinction as a necessary condition for ethical legitimacy to be established and our actions respected.
Therefore in carrying out actions that can easily invoke a moral debate it is necessary to clearly understand the doctrine of double effect and legitimize each of these actions based on the conditions that have suggested by Michael Walzer. In order to legitimize the action to take we may also consider the Sulmasy test especially so if this action is confined within the medical field. Daniel Sulmasy in this test challenges the medical practitioners to ask themselves this question if the patient were not to die after my actions would I feel that I had failed to accomplish what I had set out to do? The problems that arise from the principle of double effect can effectively be handled while considering the contributions of people like Dr. Taboada who points out that an action’s anatomy which distinguishes the action from the intention must be always considered. This draws us to a very important conclusion that will require the application of the doctrine of double effect to effectively address that is the distinguishing of intrinsic intentionality of an act and the intention of the agent.
With this in mind we can effectively conclude that the principle of double effect provides a sound basis for making a distinction between intentional effects of our actions for which we are morally responsible and the unintentional effects of the actions for which we are not morally responsible.