The Doctrine (or principle) of Double Effect is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. It is claimed that sometimes it is permissible to cause such a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end. This reasoning is summarized with the claim that sometimes it is permissible to bring about as a merely foreseen side effect a harmful event that it would be impermissible to bring about intentionally.
It is a fascinating Doctrine in that whilst on the surface it applies in Palliative Care sometimes, it also applies to bombing cities as well.
This 'doctrine' came from the work of Thomas Aquinas and many applications of this DDE can be illustrated thusly:
Many morally reflective people have been persuaded that something along the lines of double effect must be correct. No doubt this is because at least some of the examples cited as illustrations of DE have considerable intuitive appeal:
- The terror bomber aims to bring about civilian deaths in order to weaken the resolve of the enemy: when his bombs kill civilians this is a consequence that he intends. The tactical bomber aims at military targets while foreseeing that bombing such targets will cause civilian deaths. When his bombs kill civilians this is a foreseen but unintended consequence of his actions. Even if it is equally certain that the two bombers will cause the same number of civilian deaths, terror bombing is impermissible while tactical bombing is permissible.
- A doctor who intends to hasten the death of a terminally ill patient by injecting a large dose of morphine would act impermissibly because he intends to bring about the patient's death. However, a doctor who intended to relieve the patient's pain with that same dose and merely foresaw the hastening of the patient's death would act permissibly. (The mistaken assumption that the use of opioid drugs for pain relief tends to hasten death is discussed below in section 5.)
- A doctor who believed that abortion was wrong, even in order to save the mother's life, might nevertheless consistently believe that it would be permissible to perform a hysterectomy on a pregnant woman with cancer. In carrying out the hysterectomy, the doctor would aim to save the woman's life while merely foreseeing the death of the fetus. Performing an abortion, by contrast, would involve intending to kill the fetus as a means to saving the mother.
- To kill a person whom you know to be plotting to kill you would be impermissible because it would be a case of intentional killing; however, to strike in self-defense against an aggressor is permissible, even if one foresees that the blow by which one defends oneself will be fatal.
- It would be wrong to throw someone into the path of a runaway trolley in order to stop it and keep it from hitting five people on the track ahead; that would involve intending harm to the one as a means of saving the five. But it would be permissible to divert a runaway trolley onto a track holding one and away from a track holding five: in that case one foresees the death of the one as a side effect of saving the five but one does not intend it.
- Sacrificing one's own life in order to save the lives of others can be distinguished from suicide by characterizing the agent's intention: a soldier who throws himself on a live grenade intends to shield others from its blast and merely foresees his own death; by contrast, a person who commits suicide intends to bring his or her own life to an end.
I wish to put some ideas here in these pages regarding the interface and the differences between Palliative Care and Euthanasia in a sensible and serious way in the next few days.
For the purposes of the topic, I will make a clear distinction that what I am talking about is Voluntary Euthanasia and, indeed, Voluntary Palliative Care, so I am not talking about having these therapies decided or imposed by well-meaning or not well-meaning others, simply because there are too many distractions once we enter that discussion.
Often the discussions can be skewed by people with a specific ideological or religious agenda, and the topic is too serious and meaningful to allow this casual and mischievous distraction.
So, to start with a simple definition of Palliative Care:
Palliative Care is care and therapies established for a person to deal with the pain and symptoms involved with a life taking incurable illness. Often this is noted as specifically related to cancer, but this is untrue. It is any progressive incurable life taking illness which does, in fact, take life, and, indeed, doesn't give it back.
The object of Palliative Care is the removal or ablation of distress and pain usually within the last 3 months of life, based upon sensible understanding of disease trajectory...and there is very little mystery involved with disease trajectory, really.
In this way Palliative Care is really defined by its motivation: to alleviate, prevent, treat, assuage and .ameliorate distressing symptoms during the progression of disease to the death end point, and to also provide care and support for family, friends etc during and after the process. The Motivation is clear. To make life liveable whilst life endures without imposing pointless interventions onto the person in terms of invasive curative therapies when the illness is not curable.
Euthanasia, on the other hand has a different motivation, which is to end the life of the person based upon their decision, in a clear and timely fashion chosen by the person. So, the Motivation in Euthanasia is to bring about the death of the person in accordance with their wishes.
It's an interesting farewell because it is heart felt, with Tony saying goodbye to Martin Ferguson, but it is also as if he is saying goodbye to the Labor Party as an entity going into nothingness, which, in fact, is quite true. Tony mentioned the great achievements of that 'Great Party' with a certain real sadness, and that's the same kind of sadness I feel for the ALP as it approaches implosion and meaninglessness after doing quite a few great things in its long history.
It would be easy to say that the current Gillard-Swan ALP is the worst government Australia has ever had, because that is true, yet it is still a great shame that the ALP is ending, as a political and social entity, in this way.
