Doctrine of Double Effect

00:01 There are a few clinical issues in palliative care where we need to think about the ethical dimensions.

00:06 We're going to present some concepts as well as clinical situations where there might need to be some further reflection about what to do in these situations.

00:18 An important concept is something called the doctrine of double effect.

00:22 So I'm going to walk you through what the provisions of the doctrine of double effect are, and then give you an example of how this would work, when we're thinking about taking care of patients at the end-of-life or, or any time where there's this balancing of the good intentions, the good actions that we might do, and some of the negative consequences that might result from these good actions.

00:45 So here's the provisions of the doctrine of double effect.

00:48 First of all, the act itself must be good, or at least morally neutral.

00:53 So the action that we're contemplating cannot be intrinsically wrong.

01:00 Second, the good effect that we're intending must not be obtained by means of a bad effect, we are intending to do the good effect, not the bad effect.

01:10 It's recognized that the bad effect can be foreseen, but it is really not intended for itself.

01:16 We're permitting it to happen, because we're trying to achieve the good effect.

01:20 But we're not actually intending the bad effect to happen.

01:26 When you're doing this balancing of good effects and bad effects, there must be proportionately grave reason for permitting this bad effect.

01:33 So it has to be such a serious situation that you you foresee this bad effect might happen, but you still think it's worth doing, because you're gonna get the good effect.

01:41 And then lastly, you've tried all the alternatives, you know, a different course of action to try to prevent, you know, going down this path.

01:49 So all the alternative courses of action are not available not to the moral agent, you can achieve the same or equivalent good effect, while avoiding the bad effects.

01:59 So you have to move forward foreseeing this bad effect, but hoping to achieve and intending to achieve the good effect.

02:07 So the basic message for the doctrine of double effect is that it's sometimes permissible, morally permissible, to carry out an action that has a bad consequence that are foreseen, but not intended in order to achieve a good consequence.

02:22 So let me give you an example of this.

02:24 So, for instance, a patient is in severe pain, a doctor can give them a strong analgesic to alleviate the pain.

02:32 So that's the intended good consequence, the good effect, even knowing that that medication might shorten life by suppressing respiratory drive.

02:42 So generally, we think that shortening life is a bad effect.

02:47 So suppressing respiratory drive, because you're giving us such a strong pain medicine is a bad consequence, you foresee it, you're not intending that, really your intent is the pain relief.

03:00 So, again, the doctrine double effect would say, in order for you to achieve this intended good consequence, you accept the unintended, foreseen, bad consequence.