Ethics and Policy · Reproductive Ethics
RRM Academy Synopsis
Double effect can permit unintended harm under five conditions
A 2016 lecture outline by philosopher Lawrence Hinman explains that the principle of double effect allows foreseen but unintended harm under five conditions. Hinman applies it to cancer surgery in pregnancy, strong pain relief for a dying patient, and wartime bombing.
Key Findings
- Hinman introduces the principle with three scenarios: surgery for uterine cancer in a pregnant woman, large doses of morphine for a dying man, and bombing an attacker's industrial centers.
- The first conditions require a good or neutral act, an intention limited to the good effect, and a good effect that does not grow out of the bad one.
- The final two conditions require a proportionately serious reason, and no other route to the good effect that carries less moral difficulty.
- Hinman states that some acts, torture among them, are evil by their own nature, so the principle cannot excuse them under any circumstances.
- Hinman places the principle in deontological moral theories, because it depends on what the agent intends. Consequentialist theories give intention little or no weight.
Interpretation
The review is a set of lecture slides from a philosophy professor. It presents an ethical argument and reports no patient data or measured outcomes. Hinman shows how supporters of the principle reason through each case. He observes that finding a genuine intention is often hard, because people sometimes deceive others and even themselves. He also calls the choice of the relevant description of an act a difficult philosophical problem. For the problems in maintaining the doctrine, he refers readers to a Stanford Encyclopedia overview.
RRM Context
Restorative reproductive medicine builds evaluation around the cause of a condition and the aim of each intervention. The five conditions offer a structured way to examine that aim when a treatment carries a foreseeable harm, as in Hinman's opening example of cancer during pregnancy. His fifth condition favors an alternative with less moral difficulty. That matches the restorative habit of seeking the approach that works with the body's own function.
Abstract
Introduction
- A pregnant woman is diagnosed with uterine cancer. Is it permissible to operate to remove the cancer, even though doing so will result in the loss of the baby?
- A dying man is in extreme pain. Is it permissible to administer large doses of morphine to reduce the pain, even though doing so will shorten the amount of time the man has left to live?
- A country has been attacked by another. Is it morally permissible for the country that has been attacked to respond by, among other things, bombing its attacker’s industrial centers, even though doing so will also bring about the deaths of some civilian workers?
Cases
- A pregnant woman is diagnosed with uterine cancer. Is it permissible to operate to remove the cancer, even though doing so will result in the loss of the baby? Supporters of the principle of double effect will argue that it is permissible to remove the cancerous uterus (thus also terminating the pregnancy) if this is the only way to stop the spread of the cancer and if the physician does not intend to end the pregnancy, only to remove the cancer. The good effect (removal of the cancer) does not follow from the bad effect (termination of the pregnancy).
- A dying man is in extreme pain. Is it permissible to administer large doses of morphine to reduce the pain, even though doing so will shorten the amount of time the man has left to live? Again, defenders of the principle of double effect will argue that, since the genuine intent is only to relieve the pain and since there is no other way to accomplish this goal, large doses of pain killers may be permitted even though they will hasten the inevitable end of the patient's life.
- A country has been attacked by another. Is it morally permissible for the country that has been attacked to respond by, among other things, bombing its attacker’s industrial centers, even though doing so will also bring about the deaths of some civilian workers? The principle of double effect has been a cornerstone of the wartime policy of many countries, including the United States. Indeed, long range strategic bombers (such as the B-52) are essentially weapons for the mass destruction of civilian populations. Both the atomic bombs dropped on Japan were dropped on civilian centers. The Arguments The principle of double effect finds its natural home in deontological, non-consequentialist moral theories, since it turns very specifically on the intention of the moral agent. Utilitarianism and other consequentialist doctrines give little or no weight to the agent’s intentions, and as a result the principle of double effect makes little sense within such theories. We will see a similar issue arise when we discuss the difference between killing and letting die, a distinction that is much more meaningful within deontological theories than consequentialist ones. Typically, for an act to qualify as morally permissible under the principle of the double effect, a number of conditions must be met:
- The act must be morally good or at least morally neutral;
- The agent must intend only the good effect, nor the bad effect;
- The good effect cannot be the causal result of the bad effect;
- There must be a proportionately serious reason for permitting the evil effect;
- There must not be any other, less morally troubling way of accomplishing the good effect.
