The principle of double effect as a guide for medical decision-making

Abstract

Many medical interventions have both negative and positive effects. When health care professionals cannot achieve a particular desired good result without bringing about some bad effects also they often rely on double-effect reasoning to justify their decisions. The principle of double effect is therefore an important guide for ethical decision-making in medicine. At the same time, however, it is a very controversial tool for resolving complex ethical problems that has been criticized by many authors. For these reasons, I examine in this paper whether the principle of double effect can serve as a basis for ethical decisions in medicine. The conclusion reached in this article is that even though this principle has desirable effects on clinical conduct, it is only an unreliable guide and physicians and nurses cannot feel secure in continuing to use this principle for ethical guidance.

Continuous Sedation at the End of Life

“…If such an action has both a good and a bad effect and satisfies the four conditions mentioned above, then, according to this formulation of DDE, it is permitted. It should be noted that DDE only permits certain actions, but in no way confers an obligation to act; one may always choose not to perform an action that is permitted by DDE (Spielthenner 2008). Actions that do not satisfy these four conditions are considered unjustified and thus impermissible.…”

Lifespan extension and the doctrine of double effect

“…How does 'intending as an end' differ from 'intending as a means'? It has been argued that if an agent believes that her action has a certain direct effect and this belief is the rationale behind her action, the agent intends this effect as an end [19]. For example, if I write a book because I believe it will make me famous, then I intend becoming famous as an end.…”

“…The issues discussed range from the moral relevance of the intended/foresight distinction to the precise formulation of the principle [19]. However, these issues lie beyond the scope of this paper.…”

“…Some (e.g. [19]) believe that this condition rarely poses a problem when dealing with medical applications of the DDE as we may reasonably assume that medical professionals are not malevolent. Proponents of this view would, thus, argue that, in both the hysterectomy and the craniotomy case, only the good effect of preserving the mother's life is intended.…”

Senderos clínicos en la presentación de los síntomas, considerados como obra de arte plástica, en medicina de familia

“…Pero en medicina de familia este laberinto es generalmente multicursal: un lugar en el que te puedes perder; los caminos no son siempre alternativos ---pueden ser adecuados varios de ellos---, pueden tener diversas puertas de entrada, ramificaciones sin final, y diversas puertas de salida igualmente válidas, que se toman en cierto momento de la consulta o conjunto de consultas de una forma arbitraria; la consulta finaliza, aunque puede seguir en encuentros sucesivos por el mismo problema; sin final. Muchos de los caminos o intervenciones médicas pueden tener tanto efectos positivos como negativos 6 . Es habitual que sean «laberintos rizoma»: laberinto de ramificaciones infinitas, con varios senderos que llevan a distintas salidas.…”