Intention and Wrongdoing

According to the principle of double effect, there is a strict moral constraint against bringing about serious harm to the innocent intentionally, but it is permissible in a wider range of circumstances to act in a way that brings about harm as a foreseen but non-intended side effect. This idea plays an important role in just war theory and international law, and in the twentieth century Elizabeth Anscombe and Philippa Foot invoked it as a way of resisting consequentialism. However, many moral philosophers now regard the principle with hostility or suspicion. Challenging the philosophical orthodoxy, Joshua Stuchlik defends the principle of double effect, situating it within a moral framework of human solidarity and responding to philosophical objections to it. His study uncovers links between ethics, philosophy of action, and moral psychology, and will be of interest to anyone seeking to understand the moral relevance of intention.

Issue of the boundaries between good and evil in theological-moral discourse

Hardly any problem in contemporary theological-moral discourse causes such turbulence as the searching, reflection, and demarcation of the boundaries between good and evil in human acting. A fundamental problem is a criterion or a reference point according to which a person could reliably determine what is good and evil. Divergent theological views in the theological-moral dimension seem to have caused the clear boundaries between good and evil to disappear. Therefore, the crucial question is whether there is still a universal criterion for theological evaluation of a human act, as the situation in theological-moral discourse resembles an areopagus of opinions that have no common point in distinguishing between good and evil. This reflection examines the possibility if the Thomistic ethical analysis of a human act, together with the principle of double effect, may be a reference point for the demarcation of these boundaries.

‘Children are not small adults’—the distinctiveness of ethics in children

Clinicians working in paediatric palliative care encounter many of the same practical ethical quandaries that face colleagues working in the adult specialty. While the underlying moral principles must be the same, their application to children is often distinctive and ethics is an illustration that ‘children are not small adults’. The key ethical test is the child’s interests; the benefits that an intervention will offer relative to its harms. Establishing them, however, is often not straightforward, and there is a risk that interests become abstracted from the context of a caring relationship that defines the state of being a child. In this chapter we consider a number of specific challenges in paediatric ethics at the end of life: the source of authority in medical decision making, ethics of research in children, collusion (especially in older children and young adults), the principle of double effect (PDE), and euthanasia.

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.

The Doctrine of Double Effect: An Aid in Decision-Making

Human society of the modern world, which is greatly affected by technological and economic advancements, has to address moral problems with a new urgency. In many instances, the decision does not bring only positive effects. Such cases can be found in applied ethics: bio-medical ethics, business ethics, and legal ethics, but also in other areas of human activity, too, most recently, in debates, concerning the use of autonomous vehicles or autonomous machines in general. This paper aims to describe and explain the principle of ‘double effect’, when solving complicated and, from the perspective of morality, profoundly dilemmatic situations. The principle of double effect was gradually developed as a means of seeking the right moral decisions. It has a firm and respected position within Catholic medical ethics, but also in secular legislation. The paper presents current thought experiments, which clarify moral decision-making in dilemmatic situations. What seems to be a shortcoming here, is that ethical thought experiments are far too abstract. On the one hand, they refine our knowledge, but on the other hand, they are very partial. The evolution of medical imaging methods, has enabled us to take a closer look at the relationship between the deontological and utilitarian approaches to making moral judgments, but it does not relieve us of our responsibility for the decisions that we have made. The positive side of the principle of double effect, is that it protects us from the slippery slope of utilitarian consequentialism, where the admission of a lesser evil, is only a step away from committing evil in the name of the greater good.

Palliative sedation therapy for terminal movement disorders

Palliative sedation therapy (PST) can be a challenging area of palliative medicine because of the complex ethical considerations involved. PST is a medical therapy used for refractory symptoms in terminally ill patients and is often considered ethically justified due to the principle of double effect. Even in cases where PST is clearly indicated such as refractory cancer pain, there is potential for moral distress among clinicians. Here, we present a unique case in which multiple therapeutic options were limited in a patient with overlapping diagnoses of catatonia, medication-induced extrapyramidal symptoms, and dementia with Lewy bodies. We review how existing frameworks can be applied to similar situations and offer practical strategies to support medical decision-making regarding PST and reduce the risk of moral distress among clinicians.

COVID-19 Policy-Making in a Country Divided: Catholic Social Teaching as a Path to Unity

Because no vaccines or specific treatments are available, governments around the globe have responded to the Coronavirus Virus Disease 2019 (COVID-19) pandemic with a variety of nonpharmaceutical interventions (NPIs) that include sheltering-in-place orders, social distancing, and school and business closures. While the actual and potential harm due to COVID-19 is far more severe than influenza, the harms due to the NPIs—that have clearly reduced mortality due to COVID-19—are also significant. With government-ordered “lockdowns” across the globe, many arguments for and against returning to normal social and economic activity have been reported, and in fact, Americans are divided about how and when to “open up.” These arguments seem to fall into two major categories. Utilitarianism suggests that suspension of civil liberties and constitutional rights is a necessary response, while Libertarianism supports individual decision-making and greatly reduced government mandates. Protesters around the country have been vocal about one or the other points of view. First, we consider in detail the potential harms of severe acute respiratory syndrome virus-2 (SARS-CoV-2) if left unchecked by NPIs. Second, we look at harms due to restricted social and economic activity on human morbidity and mortality. Finally, we offer a framework based on the four pillars of Catholic Social Teaching and the principle of double effect that offers a more humane solution than Utilitarian or Libertarian principles alone.