The Assumption: A Dogma And Its Critics

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Issues about consent may be relevant here as well: if the vaccine recipients willingly assume the risk of experiencing adverse effects, then a full description of the program must consider their own agency in assessing the information they receive. Examples like these suggest that the cases Double Effect has been taken to apply to may involve many different dimensions of agency rather than a sharp contrast that concerns a single dimension of agency.

Critics of the principle of double effect claim that the pattern of justification used in these cases has some shared conditions: the agent acts in order to promote a good end, shows adequate respect for the value of human life in so acting, and has attempted to avoid or minimize the harm in question.

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However, they maintain that the justification for causing the harm in question depends on further substantive considerations that are not derived from the contrast between intention and foresight or the contrast between direct and indirect agency. Scanlon The principle of double effect is often mentioned in discussions of what is known as palliative care, medical care for patients with terminal illness in need of pain relief.

Three assumptions often operate in the background of these discussions:. When these assumptions are made, double effect seems to provide at least part of a justification for administering drugs to relieve pain. Yet the first assumption is false. Physicians and researchers have insisted repeatedly that it is a myth that opioids administered for pain relief can be expected to hasten death Sykes and Thorns, provide a review of a large number of studies supporting this claim.

There is no research that substantiates the claim that opioid drugs administered appropriately and carefully titrated are likely to depress respiration. There is a broad consensus that when used appropriately, respiratory depression from opioid analgesics is a rarely occurring side effect. The belief that palliative care hastens death is counter to the experience of physicians with the most experience in this area. The appropriate conclusion, then, is that double effect plays no role whatsoever in justifying the use of opioid drugs for pain relief in the context of palliative care.

Why is double effect so frequently mentioned in discussions of pain relief in the context of palliative care if its application rests on and thereby perpetuates a medical myth? The popularity and intuitive appeal of this alleged illustration of double effect may have two sources. Second, the myth that pain relief hastens death might have persisted and perpetuated itself because it expresses the compassionate thought behind the second assumption: that the hastening of death may be a welcome side effect of administering pain relief to patients at the end of life. This point of view may not be consistent with invoking Double Effect as a justification: if, in the course of treating a dying patient, death is not viewed as a harm, then Double Effect does not apply see Allmark, Cobb, Liddle, and Todd Furthermore, the apparently compassionate assumption that the hastening of death is a welcome result may be unduly paternalistic in the context of end of life care in which the patient is not dying.

Patients receiving palliative care whose pain can be adequately treated with opioid drugs may well value additional days, hours or minutes of life. It is unjustified to assume that the hastening of death is itself a form of merciful relief for patients with terminal illnesses and not a regrettable side effect to be minimized. Recall that the most plausible formulations of double effect would require agents to seek to minimize or avoid the merely foreseen harms that they cause as side effects. On this point, popular understandings of double effect, with the second assumption in place, may diverge from the most defensible version of the principle.

Some members of the U. Supreme Court invoked double effect as a justification for the administration of pain-relieving drugs to patients receiving palliative care and also as a justification for the practice known as terminal sedation in which sedative drugs are administered to patients with intractable and untreatable pain in order to induce unconsciousness Vacco et al.

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Quill et al. If artificial hydration and nutrition are not provided, sedation undertaken to deal with intractable pain may well hasten death.

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If death is immediately imminent, then the absence of hydration and nutrition may not affect the time of death. The most plausible and defensible version of the principle of double effect requires that the harmful side effect be minimized, so the principle of double effect provides no justification for withholding hydration and nutrition in cases in which death is not immediately imminent. The decision to withhold hydration and nutrition seems to depend on a judgment that death would not be a harm to the patient who has been sedated.

Terminal or full sedation is a response to intractable pain in patients suffering from terminal illness. It involves bringing about a set of conditions sedation, unconsciousness, the absence of hydration and nutrition that together might have the effect of hastening death if death is not already imminent. In any case, these conditions make death inevitable. Two important moral issues arise concerning this practice. First, is terminal sedation appropriate if it is necessary to relieve intractable pain in patients diagnosed with a terminal illness, even if death is not imminent?

This is what Cellarius calls early terminal sedation because it does not satisfy the requirement that death is imminent that is typically cited as a condition of the permissibility of terminal sedation. Early terminal sedation could be expected to hasten death as a side effect of providing palliative care for unusually recalcitrant pain. A second issue concerns the moral significance of the fact that once sedation has occurred, death is inevitable either because it was imminent already or because the withholding of nutrition and hydration has made it inevitable.

Would it be permissible to increase the level of sedation foreseeing that this would hasten the death that is now inevitable?

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Traditional applications of the principle of double effect rest on the assumption that the death of an innocent human being may never be brought about intentionally and would rule against such an action. It may obscure rather than clarify discussion of these situations to view the principle of double effect as a clear guideline. In this discussion, as in many others, the principle of double effect may serve more as a framework for announcing moral constraints on decisions that involve causing death regretfully than as a way of determining the precise content of those decisions and the judgments that justify them.

Aquinas, Saint Thomas consequentialism doing vs. Formulations of the principle of double effect 2. Applications 3. Misinterpretations 4. Criticisms 5. One principle or many loosely related exceptions? Formulations of the principle of double effect Thomas Aquinas is credited with introducing the principle of double effect in his discussion of the permissibility of self-defense in the Summa Theologica II-II, Qu. The New Catholic Encyclopedia provides four conditions for the application of the principle of double effect: The act itself must be morally good or at least indifferent.

The agent may not positively will the bad effect but may permit it. If he could attain the good effect without the bad effect he should do so. The bad effect is sometimes said to be indirectly voluntary. The good effect must flow from the action at least as immediately in the order of causality, though not necessarily in the order of time as the bad effect. In other words the good effect must be produced directly by the action, not by the bad effect. Otherwise the agent would be using a bad means to a good end, which is never allowed.

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This assumption could be made explicit as an additional condition on permissibly causing unintended harm: 5. Applications 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.

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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.

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  • The mistaken assumption that the use of opioid drugs for pain relief tends to hasten death is discussed below in section 6. 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. Misinterpretations Does the principle of double effect play the important explanatory role that has been claimed for it?

    They also include protections denied to minimize harm to civilians: Rule End of Life Decision-Making The principle of double effect is often mentioned in discussions of what is known as palliative care, medical care for patients with terminal illness in need of pain relief. Three assumptions often operate in the background of these discussions: The side effect of hastening death is an inevitable or at least likely result of the administration of opioid drugs in order to relieve pain.

    The hastening of death is a not unwelcome side effect of providing pain relief in the context of palliative care. It would be impermissible to hasten death intentionally in order to cut short the suffering of a terminally ill patient. Anscombe, Elizabeth, Aquinas, Thomas 13 th c. Baumgarth and Richard J. Regan, S. Augustine 4 th c. Bennett, Jonathan, Boyle, Joseph, Boyle, Jr. Cavanaugh, T. Cellarius, Victor, Connell, F. Davis, Nancy, Delaney, Neil Francis, Duff, Antony, Fitzpatrick, William J.

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    Fohr, Susan A. Foot, Philippa, New York: Fordham University Press, , pp. Mackie , Ted Honderich ed. Garcia, Jorge, Grisez, Germain G. Kagan, Shelly, Kamm, Frances M. Knobe, Joshua, Lackey, Douglas P. Mangan, Joseph, Marquis, Donald B. Masek, Lawrence, McCarthy, David, McIntyre, Alison, McMahan, Jeff, Mikhail, John, Nelkin, Dana K. Quinn, Warren, There are also the beliefs that every occurrence must have a cause, that nothing comes out of nothing, and that nature is governed by immutable laws.

    There is also the attitude, though not always explicitly stated, that there is no ultimate purpose to the universe at large. Yet, it must also be noted that the scientific community accepts its so-called dogmas only because they have led to valuable insights and results. Some of these have also been modified or abandoned when circumstances compellingly called for that. Consider, for example, the principle of conservation of matter and of energy, which nineteenth century took to be inviolable truths. These were abandoned with the formulation of the special theory of relativity which modified them into a matter-energy conservation principle.

    A similar situation developed in cosmology when the so-called steady-state theory was proposed. With the recognition of the Uncertainty Principle in microphysics, the notion of cause had been modified. There is the conviction on the part of many scientists that ultimately every aspect of the world, every human trait and passion, like love, hate, and compassion, can be explained by the modes and methods of science.

    Going one step further … they maintain that we then may be able to create art or replace it scientifically by certain nerve stimulations, because we then would know its neurological function. However, for over two thousand years thinkers in all civilizations did try to explain natural phenomena in terms of non-materialist underpinnings. Unfortunately, hardly any tangible knowledge seems to have arisen from such endeavors.

    Even after the rise of modern science, a number of serious and competent scientists have accepted such entities in the universe, and have spent years striving to establish scientifically their existence; but thus far, with little success. However, what makes the situation uncomfortable for anti-science thinkers is that most of the willing subscribers to these worldviews are not of the caliber to which the intellectual advocates of such views would themselves attach much weight. Also, many of the thinkers who argue that science is too narrow-minded in rejecting the possibility of supernatural phenomena have not furnished by their own endeavors any concrete evidence to their contentions.

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    This last contention cannot be denied. But until there is some justification for accepting them as such, it would be unreasonable — and futile, barring an ideological dictatorship — to condemn the scientific community as being dogmatic on this score. In the world of science, to have an open mind does not mean that one will permit anything and everything into it, but rather that the mind will not be closed to the careful consideration of any new idea.

    In the practical world, however, it is never easy to discriminate the truly original mark of genius from the ridiculous fantasies of crackpots which are sometimes presented as revolutionary insights or discoveries.

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    This does make matters difficult for the scientific community. What must be emphasized in all this is that people who reject the so-called dogmas of science are not declared heretics who are pursued or persecuted, but simply ignored. The Doctrines and Dogmas of Science. By Varadaraja Raman on November 13, in Essay. Tags: Polydoxy.