Saturday, February 26, 2011

Lingo: The Doctrine of Double Effect

In November 2009, the staff at St. Joseph's Hospital in Phoenix, Arizona had a dilemma: they could let a pregnant woman die along with her unborn child, or abort the child to save the mother's life. They chose to save one life because they could not save two.

The Catholic Church responded by declaring excommunication for those involved.1

What moral reasoning led to this?! It can't only be the result of considering unborn humans to be the moral peers of adult humans.

The Space Station

Imagine two astronauts on a space station which is struck by a micrometeoroid that destroys the life support system and passes through the skull of one of the astronauts. This injury causes unconsciousness and starts a fatal cerebral hemorrhage. The uninjured astronaut has enough equipment and expertise to know her partner will die within the next 12 hours, but the uninjured astronaut will run out of air before the repair crew arrives if her partner does not die within the next hour.

I think most people would consider this situation tragic, but ultimately agree it is morally justifiable for the astronaut who has the opportunity to survive to do so, even if it means killing — or allowing mission control to remotely kill — her already dying partner.

Official Policy

It's a safe bet that the Catholic Church would consider it as bad as murder to kill the dying astronaut. In 1995, Pope John Paul II wrote in his encyclical, The Gospel of Life:
"Therefore, by the authority which Christ conferred upon Peter and his Successors, and in communion with the Bishops of the Catholic Church, I confirm that the direct and voluntary killing of an innocent human being is always gravely immoral. [....] The deliberate decision to deprive an innocent human being of his life is always morally evil and can never be licit either as an end in itself or as a means to a good end."2
Sounds good, until you realize this particular way of honoring life sometimes requires the death of additional innocents (like the Phoenix mother or the hypothetical astronaut).

A Bit of History

Historically speaking, the Pope didn't inherit this uncompromising principle from Jesus Christ (who might have rebuked the Pope with, "The rule against killing was made to serve human life, not human life to serve the rule.")3 Instead, the official Catholic teaching originates from something St. Thomas Aquinas wrote in response to a question about killing in self-defense:
"Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention. Now moral acts take their species according to what is intended, and not according to what is beside the intention, since this is accidental [....] Accordingly the act of self-defense may have two effects, one is the saving of one's life, the other is the slaying of the aggressor. Therefore this act, since one's intention is to save one's own life, is not unlawful [....]
Nor is it necessary for salvation that a man omit the act of moderate self-defense in order to avoid killing the other man, since one is bound to take more care of one's own life than of another's. But as it is unlawful to take a man's life, except for the public authority acting for the common good, as stated above, it is not lawful for a man to intend killing a man in self-defense [....]"4
This has become known as the doctrine of double effect (or the DDE), i.e. an act with both a good and a bad effect may be morally permissible if the good effect is intended and the bad effect is unintended.

The DDE is a very fine-grained distinction. It allows a forceful defense without taking care to avoid killing an attacker, so long as the defender never thinks, "I will defend myself by killing my attacker." This makes some sense when striking an attacker's head with a heavy object, but it's hard to see how running an attacker through with a sword isn't a deliberate decision to kill. The DDE's prohibition on intending to kill as a means to a good end is the basis for not allowing a deliberate abortion as the means to save the life of a woman.

You may be wondering, "If the DDE has a loophole for unintentional killing in self-defense, might it have a loophole for unintentional abortion which saves the life of a woman?" Yes, it does!

When Cancer Is Preferable

The current policy of the United States Conference of Catholic Bishops states:
"Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child."5
This allows, for example, the removal of a cancerous uterus even if this effectively constitutes an abortion. The intent — and direct action — is the removal of the uterus, which just happens to kill anything in the uterus. The next line of the policy states, "In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion."6 This means that any implantation outside the uterus which will kill both woman and child must be allowed to kill both (not the situation in the Phoenix case, but it falls into the same category).

A More Convenient Space Station

In the original thought experiment, I pictured both astronauts together in a room with the air running out. The DDE would forbid killing the fatally injured astronaut as a means to the good end of saving the other one's life. But let's make a few modifications....

This time, the astronauts are in separate modules when the micrometeor strikes. The life control system still works, but the module containing the dying, unconscious astronaut is venting air from the entire station, which will (again) result in both astronauts dying before the repair crew arrives. The doors to the damaged module automatically sealed shut. No one in; no one out. The only thing the healthy astronaut can do to survive is shut off airflow into the damaged module.

The DDE would allow this life-saving action because the direct, intended means of saving the life of the healthy astronaut is to stop the air leak...which just happens to kill the dying astronaut inside the damaged module.

So What?

My primary goal for this post was to explain the doctrine of double effect, not so much to criticize it. I have shown how the DDE comes up in real-world life and death situations and that it responds in odd ways to the details of similar situations. This means it's a principle that is both questionable and urgently important to question.

2. Pope John Paul II. Evangelium Vitae. Part 57.
3. See Mark 2:27.
4. Aquinas. Summa Theologica. Second part of the second part. Question 64. Article 7.
5. USCCB. Ethical and religious directives for catholic health care services (fourth edition). Directive 47.
6. Ibid. Directive 48.

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