The Function of the Principle of Double Effect

WITH CONSIDERABLE frequency moral dilemmas have prompted ethicists to turn to the principle of double effect. Questions concerning sterilization, prophylactic devices, hunger-fasts, military strikes, and euthanasia have made us think of the principle as a handy problem-solving device. Raise a moral conflict, and the principle is proffered. The process of applying the principle is disturbing because it suggests that the principle itself justifies moral solutions. In ordinary use the appeal is made by stating the principle's four conditions, demonstrating that one's proposal conforms to those conditions, and subsequently arguing the licitness of one's position. The appeal presupposes, therefore, that the principle of double effect legitimates moral activity. That presupposition is dangerous, at best. Many readers can think of occasions when colleagues have invoked the principle to rescue us from otherwise regrettable courses of action. On such occasions the principle is employed to grant permissions, to render certain solutions acceptable, or simply put, to justify the morality of a particular course of action. The prevalence of this mentality is evident on the eight pages devoted to the principle of double effect in Tom Beauchamp and James Childress's Principles of Biomedical Ethics, arguably the most influential textbook today for teaching bioethics at both medical schools and seminaries. After stating the principle's four conditions, Beauchamp and Childress apply them to the case of the cancerous uterus and show how the death of the fetus "is held to be the indirect, unintended effect of a morally legitimate medical procedure." The procedure is legitimated by the principle of double effect. They write that the case of fetal craniotomy in order to save a woman in labor "is disqualified by the principle of double effect." They add that "since a papal decree in 1884, this procedure has been condemned in the Roman Catholic tradition for failing to meet the conditions of the principle of