The principle of double effect and medical ethics.
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This article focuses on the application of the ethical principles of double effect versus consequentialism, autonomy, beneficence, utility, and justice. An obstetrical case study is presented and discussion of each ethical principle is used to resolve the conflict. The intents of the article are to promote ethical awareness; provide topic areas to facilitate ethical discussion; enhance nurses' knowledge of the discipline of ethics; and support the necessity of interdisciplinary ethics committees.
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Advances in the area of pediatric medicine during the past few years have presented ethical dilemmas for the physician to consider. This article discusses the ethical principles upon which clinical reasoning and judgments can be made.
Efforts to study patient care from the perspective of Catholic ethics date back four centuries. In the course of this history, a prominent issue has always been management of pain and the efforts to avoid pain. Thus, Catholic theologians were concerned about the effects of pain medication upon the psychic function and considered whether or not hastening death for suffering people was allowed and the ethical norms for using opioids to remove pain when death is imminent. Moreover, the issue of "overmedication" for difficult or elderly patients has been a concern. The President's Commission on Ethics in Medicine and Human Research has utilized many of the principles developed by Catholic theologians when considering the matter of pain relief for dying persons.
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In caring for dying patients, physicians and health team members face a number of decisions about how best to proceed with treatment. Many of these decisions carry implications for the life of the patient, either directly or indirectly. Recent discussions about the morality and wisdom of euthanasia provide an excellent stimulus to reexamine the ethical nature of these decisions. This paper reviews five ethical principles, and describes a process of decision-making that can result in two broad paths of action in relation to life-prolonging treatment. Case examples are presented for illustration. Appropriate ethical practice can be differentiated from acting with the primary intent to take life (euthanasia).
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The doctrine of double effect shows that for which the moral agent is responsible, by explicating the relationship between the act directly intended and the consequences of that act. I contend that this doctrine is necessary not only for natural law absolutism, but also for Donagan's Kantianism and for Quinn's revised construal of the doctrine, and even for consequentialism, as bioethical implications of the doctrine make clear. For those who do not accept this necessity, I contend that it is necessary metatheoretically, in order to deal with those moral agents with irreconcilably different notions of the morally good.
The doctrine of double effect continues to be an important tool in bioethical casuistry. Its role within the Catholic moral tradition continues, and there is considerable interest in it by contemporary moral philosophers. But problems of justification and correct application remain. I argue that if the traditional Catholic conviction that there are exceptionless norms prohibiting inflicting some kinds of harms on people is correct, then double effect is justified and necessary. The objection that double effect is superfluous is a rejection of that normative conviction, not a refutation of double effect itself. This justification suggests the correct way of applying double effect to controversial cases. But versions of double effect which dispense with the absolutism of the Catholic tradition lack justification and fall to the objection that double effect is an unnecessary complication.
Recent discussions of the doctrine of double effect have contained improved versions of the doctrine not subject to some of the difficulties of earlier versions. There is no longer one doctrine of double effect. This essay evaluates four versions of the doctrine: two formulations of the traditional Catholic doctrine, Joseph Boyle's revision of that doctrine, and Warren Quinn's version of the doctrine. I conclude that all of these versions are flawed.
This essay examines the arguments for and against working towards the objective of human germ line engineering for medical purposes. Germ line changes which result as a secondary consequence of other well designed and ethically acceptable manipulations of somatic cells to cure an otherwise fatal disease can be seen as acceptable. More serious objections apply to intentional germ line interventions because of the unacceptability of using a person solely as a vehicle for creating uncertain genetic change in his descendants. It is also morally unacceptable to use the promise of future benefit to experiment on fetuses or embryos when other more effective technologies exist to help parents have healthy children. Using new genetic technologies to select desirable genotypes among gametes is less problematic and affords a promising new technique for avoiding intergenerational harms.
Determinations of the ethical acceptability of genetic therapy have relied on several distinctions in attempts to separate ethically acceptable genetic therapy from those possible therapies that could lead to genetic modifications of future human beings. One distinction that has been proposed is that genetic modifications of human somatic cells is ethically acceptable but that germ-line genetics modifications would be ethically objectionable. This paper examines several serious difficulties which call into question the ethical relevance of a somatic/germ-line distinction.
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The working party on euthanasia set up by the British Medical Association produced its report in 1988 (1). The first of its terms of reference was 'to examine the ethical problems relating to euthanasia, terminal illness, and suicide' and as far as active voluntary euthanasia (AVE) is concerned it failed conspicuously to do its job. The purpose of this article is not to restate the case for AVE but to examine the reason for the failure. (Figures in square brackets refer to sections in the report.)