Double Effect


Also see:

Traditional Doctrine of Double Effect Stanford Dictionary of Philosophy

South Australian Voluntary Euthanasia Society "Fact Sheet on "Double Effect"

The Rule of Double Effect - A Critique of Its Role in End-of-Life Decision Making. NEngl J Med 1997; 337: 1768-71)


The 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 of others.

There is controversy as to whether or not the consequence can be said to be unintended if it can be foreseen. Whatever the moral significance, intention in the mind of the physician is a dubious criterion for the framing of public policy. If life is deliberately shortened or ended in this way in the guise of symptom relief, it may be classed as "indirect euthanasia." This appears to be resorted to not infrequently by doctors acting from compassion

See the Fact Sheet on "double effect"


For clinicians and others who believe in an absolute prohibition against actions that intentionally cause death, the rule of double effect may be useful as a way of justifying adequate pain relief and other palliative measures for dying patients. But the rule is not a necessary means to that important end. Furthermore, the rule's absolute prohibitions, unrealistic characterization of physicians' intentions, and failure to account for patients' wishes make it problematic in many circumstances. In keeping with the traditions of medicine and broader society, we believe that physicians' care of their dying patients is properly guided and justified by patients' informed consent, the degree of suffering, and the absence of less harmful alternatives to the treatment contemplated.

( "The Rule of Double Effect -- A Critique of Its Role in End-of-Life Decision Making." The New England Journal of Medicine -- December 11, 1997 -- Vol. 337, No. 24, by Timothy E. Quill, M.D., Rebecca Dresser, J.D., and Dan W. Brock, Ph.D.)

See the Fact Sheet on "double effect"

See The Rule of Double Effect - A Critique of Its Role in End-of-Life Decision Making. NEngl J Med 1997; 337: 1768-71)


Stanford Encyclopedia of Philosophy

According to the traditional doctrine of double effect it is permissible to act in ways which it is foreseen will have bad consequences provided only that

(a) this occurs as a side effect (or indirectly) to the achievement of the act which is directly aimed at or intended; (b) the act directly aimed at is itself morally good or, at least, morally neutral; (c) the good effect is not achieved by way of the bad, that is, the bad must not be a means to the good; and (d) the bad consequences must not be so serious as to outweigh the good effect.

In line with the doctrine of double effect it is, for example, held to be permissible to alleviate pain by administering drugs like morphine which it is foreseen will shorten life, whereas to give an overdose or injection with the direct intention of terminating a patient’s life (whether at her request or not) is considered morally indefensible. This is not the appropriate forum to give full consideration to this doctrine. However, there is one vital criticism to be made of the doctrine in relation to the issue of voluntary euthanasia. With that point made we will be able to turn to the more general question of the moral permissibility of intentional killing.

The criticism of the relevance of the doctrine of double effect to any critique of voluntary euthanasia is simply this: the doctrine can only be relevant where a person’s death is an evil or, to put it another way, a harm. Sometimes "harm" is understood simply as damage to a person’s interest whether consented to or not. At other times it is more strictly understood as wrongfully inflicted damage. On the latter understanding consent becomes crucial. Unless paternalistic interference is judged to be appropriate the giving of consent removes any suggestion of wrongfulness. So, if the death of a person who wishes to die is not harmful (because from that person’s standpoint it is, in fact, beneficial), the doctrine of double effect can have no relevance to the debate about the permissibility of voluntary euthanasia.


D. Brock, ‘Voluntary Active Euthanasia’, Hastings Center Report 22, no. 2 (1993) pp. 10-22.

Commission on the Study of Medical Practice Concerning Euthanasia: Medical Decisions Concerning the End of Life (The Hague: SdU, 1991) - otherwise known as ‘The Remmelink Report’.

H. Kuhse, The Sanctity-of-Life Doctrine in Medicine: A Critique (Oxford: Clarendon Press, 1987).

J. Rachels, The End of Life: Euthanasia and Morality (Oxford: Oxford University Press, 1986).

P.J. van der Maas, J.J.M. van Delden, L. Pijnenborg, C.W.N. Looman, "Euthanasia and other Medical Decisions Concerning the End of Life", The Lancet 338 (1991) pp. 669-674. * P.J. van der Maas, G. van der Wal, I. Haverkate, C.L.M. de Graaf,

J.G.C. Kester, B.D. Onwuteaka-Philipsen, A. van der Heide, J.M. Bosma and D.L. Willems, "Euthanasia, Physician-Assisted Suicide, and other Medical Practices Involving the End of Life in the Netherlands, 1990-1995", The New England Journal of Medicine 335 (1996) pp. 1699-1705.

G. van der Wal, J.Th.M. van Eijk, H.J.J. Leenen, C. Spreeuwenberg, "Euthanasia and Assisted Suicide, I: How Often is it Practised by Family Doctors in the Netherlands?", Family Practice 9 (1992a) pp. 130-134.

G. van der Wal, J.Th.M. van Eijk, H.J.J. Leenen, C. Spreeuwenberg, "Euthanasia and Assisted Suicide, II: Do Dutch Family Doctors Act Prudently?", Family Practice 9 (1992b) pp. 135-140.

G. van der Wal, P.J. van der Maas, J.M. Bosma, B.D. Onwuteaka-Philipsen, D.L. Willems, I. Haverkate and P.J. Kostense, "Evaluation of the Notification Procedure for Physician-Assisted Death in the Netherlands", The New England Journal of Medicine 335, (1996) pp. 1706-1711.

E. Winkler, "Reflections on the State of Current Debate Over Physician-Assisted Suicide and Euthanasia", Bioethics 9 (1995) pp. 313-326.

R. Young, "Voluntary and Nonvoluntary Euthanasia", The Monist 59 (1976) pp. 264-283.