following Fact Sheet has been prepared by the South Australian Voluntary Euthanasia
Society (SAVES). For further information visit their website at http://www.saves.asn.au
Voluntary Euthanasia Society
Principle of Double Effect
ethical principle of Double Effect is used to justify medical treatment
designed to relieve suffering where death is its unintended (though foreseen)
consequence. It comes from "the rule of double effect" developed by Roman
Catholic moral theologians in the Middle Ages as a response to situations
requiring actions in which it is impossible to avoid all harmful consequences.
The rule makes intention in the mind of the doctor a crucial factor in judging
the moral correctness of the doctor's action because of the Roman Catholic
teaching that it is never permissible to "intend" the death of an
"innocent person". An innocent person is one who has not forfeited the right
to life by the way he or she behaves, eg, by threatening or taking the lives
rule applies if:
the desired outcome is judged to be "good" (eg relief of suffering);
"bad" outcome (eg death of patient) is not intended;
"good" outcome is not achieved by means of the "bad";
"good" outcome outweighs the "bad".
the rule, administering medication in dosages likely to cause death in order
to relieve a terminally ill patient's suffering is morally correct, provided
the above four conditions are met.
are many who regard the rule of double effect as seriously flawed. Grounds
for its rejection include:
rule is not consistently applied. For example, when serious suffering
cannot otherwise be relieved, "terminal sedation" is permissible in law
and in medical ethics. This means rendering the patient unconscious until
death occurs. Yet it also means withholding life-preserving measures so
that death, which is thereby hastened and inevitable, must be considered
are often ambiguous. They may be contradictory, and they are always subjective.
They cannot be realistically analysed in terms of the presence or absence
of one clear purpose.
some cases the moral and legal validity of a particular medical treatment
will hinge on the claimed intention of the doctor. This is an unsound
basis for public policy.
ordinary life we hold ourselves and others morally responsible for the
reasonably foreseeable consequences of our actions. Doctors should not
be exempt from this.
the rule offers the doctor a convenient evasion of responsibility, it
takes no account of the wishes of the patient whose life (and death) it
is. Many regard the issues of:
patient's right of self-determination and bodily integrity;
provision of informed consent;
absence of less harmful alternatives acceptable to the patient and
severity of the patient's suffering
as the factors which should determine the moral and legal validity of
the doctor's actions rather than whether or not the doctor "intended"
the patient to die.
reading, including 42 references, is contained in the New England Journal
of Medicine of 11 December 1997 (Quill TE, Dresser JD, Brock DW. The Rule
of Double Effect - A Critique of Its Role in End-of-Life Decision Making.
N Engl J Med 1997; 337: 1768-71). See also Correspondence, N Engl J Med 1998;
information contact SAVES at: http://www.saves.asn.au
contact: Hon Secretary, SAVES, PO Box 2151, Kent Town, SA 5071, Australia
- Fax + 61 8 8265 2287