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The principle of double effect is a concept in normative ethics that helps determine the most ethical course of action in situations where an intended beneficial outcome may also result in a morally negative side effect. This principle is commonly employed by Catholic theologians and bioethicists when considering medical procedures that could lead to abortion or euthanasia, as well as in discussions regarding just war tactics.
Originating from Thomas Aquinas’ Summa Theologiae, the principle of double effect can be found in Question 64, Murder, Article 7, where Aquinas explores the ethics of self-defense. He begins by referencing Augustine’s belief that while killing in self-defense might be legally permissible, it is morally wrong. Augustine argued against valuing material possessions over moral principles, stating that one should not prioritize physical goods over ethical integrity, including one’s own life. Aquinas presents additional arguments against killing in self-defense, such as the comparison to adultery and the admonition against seeking revenge in Romans 12:19. He suggests that self-defense, as a preemptive action, is more severe than seeking retribution.
Aquinas ultimately concludes that self-defense is justified by natural law, but only if the response is proportionate to the threat. If the defender’s reaction is excessive and leads to the death of the aggressor, then the act of self-defense becomes unethical. While taking a life is inherently wrong, failing to protect oneself due to fear of causing harm is also unethical. Aquinas asserts that intentional killing is only justifiable when authorized by a legitimate governing body, such as in the roles of a soldier or a law enforcement officer.
Subsequent ethicists expanded Aquinas’ ideas on self-preservation to encompass scenarios where pursuing a good end may have unintended negative consequences, particularly involving loss of life. They
Arrived at four principles that characterize double effect:
1. The act itself must be morally good or neutral;
2. Although the agent may foresee morally grave harm, he must not desire it;
3. The good result must arise because of the action, not the negative effect;
4. The value of the good result must outweigh the harm of the negative effect.
The principles of double effect encompass the primary categories of normative ethics. An act may be identified as wrong or right using deontology and Christian ethics. The agent’s desire reflects their character, which is addressed in virtue ethics. The order and nature of the good and bad effects may be related to ethical relativism. The belief that the good must outweigh the bad is an application of consequentialism.
Double effect can be applied to various scenarios, but it is mainly utilized by medical professionals to determine the ethicality of a treatment. Particularly in Catholic hospitals, the two most common situations scrutinized involve abortion and euthanasia.
When applied to euthanasia, the principle of double effect balances the relief of pain, which is good, against a potentially shortened lifespan, which is bad. Double effect dictates that medication may be administered only if the primary intention is to alleviate pain and not to hasten death.
The double effect framework is at times employed to determine the extent of medical treatment. For instance, in the case of an ectopic pregnancy, it is understood that the baby will not survive, and the mother may not either. Removing the fetus early on is a straightforward procedure, but technically constitutes an abortion. Therefore, a doctor may opt to remove the entire fallopian tube. While the removal of the fallopian tube is typically unnecessary, it allows for the perspective that the baby’s death is not the cause of the mother’s survival but merely a consequence.
Double effect is also considered in discussions regarding matters of war. It is considered ethical to bomb a military installation or a strateg
ic target, such as a bridge, even if civilians are present, because the death of civilians, although foreseen, is undesired. The bombing of civilians to demoralize the government into surrender is deemed unethical. However, because the good (demoralization) is a direct consequence of the bad (civilian casualties). In cases such as these, steps are often added to mitigate the harm, like notifying the civilians of the impending bombing before destroying the infrastructure.
The trolley track switch, a traditional ethical dilemma, can also be analyzed using double effect. A trolley is barreling down a track, approaching a Y. Ahead stand five people who cannot move. Along an adjacent track stands one person. According to double effect, a bystander may throw the switch and divert the trolley so the one person dies rather than the five. The desire is to save the five people; the act is to switch the track. The death of the one person does not directly lead to the five being saved; it is a foreseen but undesired side effect, and one of proportionately less weight than the deaths of five people. The bystander may not, however, throw another person in front of the trolley to stop it. The crushed person would stop the trolley, but the saving of the five lives would be a direct result of the one person’s death and would therefore be unethical.
Double effect can be used on a number of other issues. Is it ethical to use vaccinations to prevent life-threatening disease if a handful of people will fall victim to conditions such as Guillain-Barre syndrome? Is it ethical for a soldier to dive onto a live grenade if his death will directly save those around him? Is eminent domain ethical if a new dam will control flooding and provide electricity, even if several houses are destroyed? Is it right to cut off a hand trapped by a boulder if the alternative is to die of exposure?
The principle of double effect is not an absolute tool. Acts themselves are not always right or wrong. And questions remain: can applying double effect contradict a living will? How much should the acting agent work to minimize the chance and extent of the harm?
Double effect is beneficial because it allows agents to pause and contemplate the repercussions of their actions. It also provides solace to healthcare professionals confronted with challenging dilemmas that lack a clear-cut answer. Naturally, challenging decisions should always involve prayer and surrender to the guidance of the Holy Spirit. God’s goodness surpasses human understanding. As stated in James 1:5, “If any of you lacks wisdom, you should ask God, who gives generously to all without finding fault, and it will be given to you.”
