Double-effect Reasoning Research Articles

Double-Effect Donation or Bodily Respect? A "Third Way" Response to Camosy and Vukov.

Is it possible to donate unpaired vital organs, foreseeing but not intending one's own death? We argue that this is indeed psychologically possible, and thus far agree with Charles Camosy and Joseph Vukov in their recent paper on "double effect donation." Where we disagree with these authors is that we see double-effect donation not as a morally praiseworthy act akin to martyrdom but as a morally impermissible act that necessarily disrespects human bodily integrity. Respect for bodily integrity goes beyond avoiding the aim to kill: not all side effects of deliberate bodily interventions can be outweighed by intended benefits for another even if the subject fully consents. It is not any necessary intention to kill or harm another or oneself that makes lethal donation/harvesting illicit but the more immediate intention to accept or perform surgery on an (innocent) person combined with the foresight of lethal harm and no health-related good for him or her. Double-effect donation falls foul of the first condition of double-effect reasoning in that the immediate act is wrong in itself. We argue further that the wider effects of such donation would be socially disastrous and corrupting of the medical profession: doctors should retain a sense of nonnegotiable respect for bodily integrity even when they intervene on willing subjects for the benefit of others. Summary: Lethal organ donation (for example, donating one's heart) is not a praiseworthy but a morally impermissible act. This is not because such donation necessarily involves any aim to kill oneself (if one is the donor) or to kill the donor (if one is the surgeon). Respect for bodily integrity goes beyond avoiding any hypothetical aim to kill or harm oneself or another innocent person. 'Double effect donation' of unpaired vital organs, defended by Camosy and Vukov, is in our view a form of lethal bodily abuse and would also harm the transplant team, the medical profession and society at large.

Can double‐effect reasoning justify lethal organ donation?

The dead donor rule (DDR) prohibits retrieval protocols that would be lethal to the donor. Some argue that compliance with it can be maintained by satisfying the requirements of double-effect reasoning (DER). If successful, one could support organ donation without reference to the definition of death while being faithful to an ethic that prohibits intentionally killing innocent human life. On the contrary, I argue that DER cannot make lethal organ donation compatible with the DDR, because there are plausible ways it fails DER's requirements. A key takeaway is that the theories of intention and proportionality assumed in DER matter for its plausibility as a constraint on practical reasoning.

Double-Effect Donation Disputed.

In "Double Effect Donation," Camosy and Vukov argue that "there are circumstances in which it is morally permissible for a healthy individual to donate their organs even though their death is a foreseeable outcome". They propose that a living donor could ethically donate an entire, singular, vital organ while knowing that this act would result in death. In reply, I argue that it is not ethical for a living person to donate an entire, singular, vital organ. Moreover, mutatis mutandis, it is not ethical for surgeons and others to perform such a deadly operation. For to do so is "intentionally to cause the death of the donor in disposing of his organs". Such an act violates the dead donor rule which holds that an entire, singular, vital organ may be taken only from a corpse. Contrary to Camosy and Vukov's claims, double-effect reasoning does not endorse such organ donation.

Palliative Sedation, Compassionate Extubation, and the Principle of Double Effect: An Ethical Analysis.

Palliative sedation is a well-recognized and commonly used medical practice at the end of life for patients who are experiencing refractory symptoms that cannot be controlled by other means of medical management. Given concerns about potentially hastening death by suppressing patients' respiratory drive, traditionally this medical practice has been considered ethically justifiable via application of the ethical doctrine known as the Principle of Double Effect. And even though most recent evidence suggests that palliative sedation is a safe and effective practice that does not hasten death when the sedative medications are properly titrated, the Principle of Double Effect is still commonly utilized to justify the practice of palliative sedation and any risk-however small-it may entail of hastening the death of patients. One less common clinical scenario where the Principle of Double Effect may still be appropriate ethical justification for palliative sedation is when the practice of palliative sedation is pursued concurrently with the active withdrawal of life-sustaining treatment-particularly the practice of compassionate extubation. This case study then describes an unconventional case of palliative sedation with concurrent compassionate extubation where Principle of Double Effect reasoning was effectively employed to ethically justify continuing to palliatively sedate a patient during compassionate extubation.

Artificial Nutrition and Hydration and Care at the End of Life

New Natural Law Theory and the Catholic medico-moral tradition often lead to similar conclusions in hard cases regarding end-of-life care. Considering the provision of artificial nutrition and hydration to patients suffering from post-coma unresponsive wakefulness, however, brings to light subtle ways in which NNL differs from the centuries-old natural law tradition. In this essay, I formalize the methodology embedded within the casuistry of the medico-moral tradition and show how it differs from NNL with respect to the role played by double-effect reasoning and the perspective for analyzing cases regarding care for those who cannot speak for themselves. Importantly, the ordinary/extraordinary means distinction has never historically been understood as an application of double effect and logically cannot be so understood. Given the outsized role that double effect plays in NNL, the theory leads to conclusions that deviate from the Catholic medico-moral tradition and creates additional burdens and duties for the sick.

Previable Induction of Labor for Life-Threatening Maternal Disease without Placental Pathology

Pregnancy causes maternal pathology by combining maternal predispositions with healthy physiology. In maternal cardiovascular collapse, previable induction of labor is justifiable despite the definition of abortion in directive 45 of the Ethical and Religious Directives for Catholic Health Care Services. Central to this conclusion, the placenta is a fetal organ, and pregnancy is a cardiovascular condition placing new demands on the maternal cardiovascular system. Previable delivery, a morally neutral separation, addresses the cause of pathology even if fetal death is anticipated. This is acceptable under double-effect reasoning. Directive 45 defines all previable deliveries as abortions, so this analysis proposes an alternative definition established by obstetrician/gynecologists.

Bioethical and Moral Perspectives in Human Reproductive Medicine.

On the occasion of the fiftieth anniversary of the promulgation of Pope Paul VI's encyclical Humanae vitae, this article seeks to defend its enduring relevance to modern-day society, through application of its reasoning to contemporary dilemmas in reproductive medicine. It considers real cases of the ethics of prescribing hormonal contraceptives, of investigating male infertility, of cooperating in counseling and assisting conception in same-sex relationships, of ART, of prenatal adoption, and the application of double-effect reasoning.

Comforting when we cannot heal: the ethics of palliative sedation.

This essay considers whether palliative sedation is or is not appropriate medical care. This requires one to consider (a) whether, in addition to the good of health, relief of suffering is also a proper end of medicine; (b) whether unconsciousness can ever be a good for a human being; and (c) how double-effect reasoning can help us think about difficult cases. The author concludes that palliative sedation may be proper medical care, but only in a limited range of cases.

Knowing, Anticipating, Even Facilitating but Still not Intending: Another Challenge to Double Effect Reasoning.

A recent administrative law decision in Victoria, Australia, applied double effect reasoning in a novel way. Double effect reasoning has hitherto been used to legitimate treatments which may shorten life but where the intent of treatment is pain relief. The situation reviewed by the Victorian tribunal went further, supporting actions where a doctor agrees to provide pentobarbitone (Nembutal) to a patient at some time in the future if the patient feels at that time that his pain is unbearable and he wants to end his life. The offer to provide the drug was described as a palliative treatment in that it gave reassurance and comfort to the patient. Double effect reasoning was extended in this instance to encompass potentially facilitating a patient's death. This extension further muddies the murky double effect reasoning waters and creates another challenge to this concept.

Further clarity on cooperation and morality

I explore the increasingly important issue of cooperation in immoral actions, particularly in connection with healthcare. Conscientious objection, especially as pertains to religious freedom in healthcare, has become a pressing...

Double-effect reasoning in Paradise Lost: an investigation into Milton's God's will in humankind's Fall

Double-effect reasoning in Paradise Lost: an investigation into Milton's God's will in humankind's Fall

Catholic Teaching on Sex-Reassignment

Carol Bayley’s double-effect reasoning in defense of sex-reassignment surgery fails at the opening. The first condition of the principle is that the act in itself must be morally good or at least neutral. She says, without argument, “the surgery itself is neutral.” How so? The surgery is a direct assault on the physical integrity of a person whose sexual organs are perfectly healthy. Is it reasonable to say that a person who wants to change gender has a body that is in fact seriously deformed or diseased? Where is the evidence? If reality is defined by the mind, then the imagination may freely think of personal identity in any conceivable way. Nature is set aside and in its place is put, at best, a delusion and, at worst, an ideology that seeks to do violence to nature. Catholic hospitals should not participate in this assault upon God’s creation.

Double Effect and Black Revenge in Lessing’s The Grass Is Singing

A white woman’s murder by a black man, as depicted in Doris Lessing’s The Grass IS Singing , incorporates the revengeful act of an abandonment-neurotic black servant against a white female master with tactile delirium in the course of a paradoxical relationship of love and hate. The final homicide and the consequent act of surrender by Moses, the murderer, convey his paradoxical attitude toward his white master-beloved. This attitude begins with hatred, intensifies with mutual affection, and ends in murder. Focusing on the interracial revenge that takes place in the novel under study, the authors of this paper argue that Moses’ motivation in killing Mary originates from the ambivalence of his state of living under colonization and his learnings in Christianity, struggling with the Double-Effect Reasoning inaugurated by and in defense of black honor or negritude. As such, Moses’ sense of guilt and his subsequent surrender are the consequences of traditional and colonial internalization of sin, already present in him as a native of his revenge or honor-based society, influenced by Lobengula’s rule in which the criminal submits to punishment willingly, as well as missionary teachings. Through an interdisciplinary link between the Double-Effect Reasoning and the psychoanalytical perspective to the black problem promoted by Frantz Fanon, The Grass Is Singing thus seems to exempt Moses in his crime against the white race, represented by Mary, as well as to justify Moses self-surrender in defense of negritude and black honor.

Lifespan extension and the doctrine of double effect

Recent developments in biogerontology--the study of the biology of ageing--suggest that it may eventually be possible to intervene in the human ageing process. This, in turn, offers the prospect of significantly postponing the onset of age-related diseases. The biogerontological project, however, has met with strong resistance, especially by deontologists. They consider the act of intervening in the ageing process impermissible on the grounds that it would (most probably) bring about an extended maximum lifespan--a state of affairs that they deem intrinsically bad. In a bid to convince their deontological opponents of the permissibility of this act, proponents of biogerontology invoke an argument which is grounded in the doctrine of double effect. Surprisingly, their argument, which we refer to as the 'double effect argument', has gone unnoticed. This article exposes and critically evaluates this 'double effect argument'. To this end, we first review a series of excerpts from the ethical debate on biogerontology in order to substantiate the presence of double effect reasoning. Next, we attempt to determine the role that the 'double effect argument' is meant to fulfil within this debate. Finally, we assess whether the act of intervening in ageing actually can be justified using double effect reasoning.

Jean Pierre Gury's Sources: A Missing Chapter in the History of Double Effect

Analysis of Gury's sources for his two principles governing the indirect voluntary both illuminates its historical development and raises questions about its meaning. The historical review reveals not only that Gury relied far more on later theologians than on Thomas Aquinas in formulating his principles, but also that two critical changes in the understanding of the indirect voluntary have created a deceptive appearance of historical continuity regarding double-effect reasoning.

Embryo deaths in reproduction and embryo research: a reply to Murphy's double effect argument

The majority of embryos created in natural reproduction die spontaneously within a few weeks of conception. Some have argued that, therefore, if one believes the embryo is a person (in...

Double-effect reasoning and the conception of human embryos

Some commentators argue that conception signals the onset of human personhood and that moral responsibilities toward zygotic or embryonic persons begin at this point, not the least of which is...

Double-effect Reasoning Defended

Common morality endorses some form of an exceptionless prohibition against killing innocents. Natural lawyers employ double-effect reasoning (DER) to address hard cases involving deaths of the innocent. Current deontologists (Scanlon and Thomson) criticize DERproponents as conflating actwith agent-evaluations. Scanlon develops this critique extensively. I respond to his criticism. He maintains that the DER-advocate tells a badly-motivated agent to refrain from an obligatory act. Thus, he asserts, the natural lawyer who employs DER errs. Instead, Scanlon proposes, one ought to assess the act as permissible while blaming the agent. I argue that DER does not succumb to this critique. Moreover, Scanlon’s particular criticism nicely shows the reasonableness of the approach the DER-thinker takes, namely, that defective agents produce defective acts. Thus, employing DER does not lead to a confusion of actwith agentevaluations. Rather, it results in coherent assessments of both. “The denial of any distinction between foreseen and intended consequences, as far as 2 responsibility is concerned, was not made by Sidgwick in developing any one ‘method of ethics’; he made this important move on behalf of everybody and just on its own account; and I think it plausible to suggest that this move on the part of Sidgwick explains the difference between old-fashioned utilitarianism and that consequentialism, as I name it, which marks him and every English academic philosopher since him. By it, the kind of consideration which formerly would have been regarded as a temptation, the kind of considerations urged upon men by wives and flattering friends, was given a status by moral philosophers in their theories. It is a necessary feature of consequentialism that it is a shallow philosophy.” –G. E. M. Anscombe, Modern Moral Philosophy

Threat of Imminent Death in Pregnancy: A Role for Double-Effect Reasoning

In the Phoenix case, pulmonary hypertension threatened the life of an eleven-week pregnant mother. Removal of the placenta as the organ threatening the mother's life necessarily included extracting the amniotic membranes containing the fetus. The author proposes this argument: the principle of double effect clarifies that causing the death of the fetus (destined to die, whatever transpired) while avoiding a direct physical assault on it constitutes an indirect and unintended (albeit foreseen) side effect, thereby justifying the intervention.

The Morality of Cluster Bombing

Consensus among human rights groups and churches in recent years about cluster bombs has culminated in the Convention on Cluster Munitions. While there is apparent agreement that cluster bombs ought to be illegal, no substantive ethical treatment of this issue exists. In statements, references are typically made to the danger cluster munitions pose to civilians; it is alleged that these weapons are inherently immoral, and appeal is given only implicitly or in a cursory fashion to traditional just war reasoning. Taking its cue from Jesuit moral theologian John C. Ford's influential article appearing in 1944 on `The Morality of Obliteration Bombing', and drawing on the more recent work of Oliver O'Donovan on `immoral weapons', this essay offers a critical moral assessment of cluster bombs and their use through attention to the principles of discrimination, proportionality, and the framework of double effect reasoning.