Here is a very insightful and readable article about the Passion, and the modern world's impression of how Pontius Pilate was betrayed. Of course, these days we meditate not so much on Pilate, but on the Truth standing before him, but this helps anyway.
http://nationalreview.com/comment/de_souza200404080847.asp
Fr. Raymond de Souza is Catholic Chaplain of Newman Center at Queen's University, Kingston.
Thursday, April 08, 2004
Thursday, April 01, 2004
Applying Double Effect in Medicine
[Email from professor]
I thought I'd follow up a little bit on our discussion
about the doctrine of double effect (DDE) today. The
intent is a primary component of the doctrine.
Let's take the example of the mother in labour whose
life is being threatened. In scenario 1, the baby's
head is too big to be delivered, the mother will die
secondary to labour (perhaps because her blood pressure
is too high) and the options are either to continue the
delivery because the baby cannot be pulled back out
via caesarian section and the likely outcome is that the
mother will die, and perhaps the baby too OR the
baby's skull is collapse resulting in its death but the
mother is saved.
In scenario 2, the mother is having life threatening
placental hemorrhage, and needs to have an emergency
hysterectomy to save her life. In this case, the baby
may die as a result of the emergency hysterectomy
because it is still in the uterus and cannot be delivered
without the mother dying in the process.
How are these 2 situations different?
In scenario 1, the method by which the mother's life
will be saved is through the death of the baby.
Therefore according to DDE it is not justifiable since the
"intent" is to kill the baby, which will result in
saving the mother. The intended outcome of the action
(killing the baby and ending the labour) is immoral, and
even if the indirect outcome (saving the mother) is
good.
In scenario 2, the method by which the mother's life
will be saved is via hysterectomy. It is justifiable
since the "intent" is to save the mother. The intended
outcome of the action (saving the mother by stopping
the hemorrhage) is moral, while the unintended although
inextricably linked outcome (death of the baby) is
only secondary.
Of course, the intent in this circumstance is linked
to the deontological rule/commandment "thou shalt not
kill", but the issue here is that in scenario 1 killing
is the intended action, where in scenario 2 it is an
unavoidable consequence.
Personally I have difficulties with DDE once I start
thinking too much about it. It can be "wrongly" used
to either justify problematic actions or inaction
(e.g., letting the mother die in scenario 1 when the baby
will die anyways, too). It can also be twisted when we
start thinking of withdrawing treatment or
administering palliative medications at the end of life--semantic
arguments about whether you believed someone was going
to die or whether you were letting the natural course
of their disease progress.
Anyways, I hope you enjoyed class and that I clarified
some of your questions about DDE.
Cheers,
[quisutdeus responds]
The principle of double effect allows one to perform an action which has two effects, one good and the other bad, provided the following four conditions are met simultaneously: (cf. Germain Grisez)
1. the act itself must be good or at least morally neutral,
2. the agent must intend the good effect,
3. the good effect must not result from the bad effect,
4. and there must be a proportionately grave reason to justify the act (good effect outweighs bad).
I'm not sure you properly apply DDE in the first of your two scenarios, even though I agree with the conclusions. In scenario 1, the action itself (collapsing the baby's skull) is always wrong, even apart from consideration of the good effect that follows, for to kill an innocent person is intrinsically immoral. For this reason it fails to satisfy the first criterion and double effect cannot apply.
The argument from "intent" fails to distinguish the two scenarios. Intent is an act of the will in a reasoning being capable of freely choosing. In both scenarios the effect primarily intended by most surgeons is to save the life of the mother. The surgeon achieves the desired end differently in each case (she DOES something differently). In both cases the death of the baby (hysterectomy resulting in baby dying and evacuation of baby's brain resulting in baby dying) is unintended by the agent. In one case, however, when the surgeon says, "we couldn't save your baby," she means that she killed your baby. In the other case she means she did all she could, but the baby died as was foreseen. The moral distinction between the two is made in reference to the act itself.
A couple of things follow from the four criteria that we may grapple with personally.
The first is that sometimes we will have to allow an innocent mother to die because we are morally unable to kill the innocent baby trapped in her birth canal. While this is extremely tragic (as well as exceedingly rare) there are profoundly positive cultural implications to be obtained by affirming life not only in principle (thou shalt not kill - dignity of personhood, etc.) but also in act.
Second, the principle of double effect can work the other way in scenario 1, where the (consenting) mother can be operated on to save the baby, with the high probability that she will die during surgery. The case of Gianna Bretta Molla, an Italian pediatrian, is similar. She refused surgery to remove a large ovarian cyst during her pregnancy because it would result in the death of her child. She died shortly after giving birth in 1962.
Third, the intent itself is enough to vitiate a morally neutral or even good act. In the second scenario, for instance, if the surgeon performing the hysterectomy intends to kill the baby to save the mother, the surgeon IS morally guilty of killing the baby.
I enjoyed your comments. Let me know what you think of these.
I thought I'd follow up a little bit on our discussion
about the doctrine of double effect (DDE) today. The
intent is a primary component of the doctrine.
Let's take the example of the mother in labour whose
life is being threatened. In scenario 1, the baby's
head is too big to be delivered, the mother will die
secondary to labour (perhaps because her blood pressure
is too high) and the options are either to continue the
delivery because the baby cannot be pulled back out
via caesarian section and the likely outcome is that the
mother will die, and perhaps the baby too OR the
baby's skull is collapse resulting in its death but the
mother is saved.
In scenario 2, the mother is having life threatening
placental hemorrhage, and needs to have an emergency
hysterectomy to save her life. In this case, the baby
may die as a result of the emergency hysterectomy
because it is still in the uterus and cannot be delivered
without the mother dying in the process.
How are these 2 situations different?
In scenario 1, the method by which the mother's life
will be saved is through the death of the baby.
Therefore according to DDE it is not justifiable since the
"intent" is to kill the baby, which will result in
saving the mother. The intended outcome of the action
(killing the baby and ending the labour) is immoral, and
even if the indirect outcome (saving the mother) is
good.
In scenario 2, the method by which the mother's life
will be saved is via hysterectomy. It is justifiable
since the "intent" is to save the mother. The intended
outcome of the action (saving the mother by stopping
the hemorrhage) is moral, while the unintended although
inextricably linked outcome (death of the baby) is
only secondary.
Of course, the intent in this circumstance is linked
to the deontological rule/commandment "thou shalt not
kill", but the issue here is that in scenario 1 killing
is the intended action, where in scenario 2 it is an
unavoidable consequence.
Personally I have difficulties with DDE once I start
thinking too much about it. It can be "wrongly" used
to either justify problematic actions or inaction
(e.g., letting the mother die in scenario 1 when the baby
will die anyways, too). It can also be twisted when we
start thinking of withdrawing treatment or
administering palliative medications at the end of life--semantic
arguments about whether you believed someone was going
to die or whether you were letting the natural course
of their disease progress.
Anyways, I hope you enjoyed class and that I clarified
some of your questions about DDE.
Cheers,
[quisutdeus responds]
The principle of double effect allows one to perform an action which has two effects, one good and the other bad, provided the following four conditions are met simultaneously: (cf. Germain Grisez)
1. the act itself must be good or at least morally neutral,
2. the agent must intend the good effect,
3. the good effect must not result from the bad effect,
4. and there must be a proportionately grave reason to justify the act (good effect outweighs bad).
I'm not sure you properly apply DDE in the first of your two scenarios, even though I agree with the conclusions. In scenario 1, the action itself (collapsing the baby's skull) is always wrong, even apart from consideration of the good effect that follows, for to kill an innocent person is intrinsically immoral. For this reason it fails to satisfy the first criterion and double effect cannot apply.
The argument from "intent" fails to distinguish the two scenarios. Intent is an act of the will in a reasoning being capable of freely choosing. In both scenarios the effect primarily intended by most surgeons is to save the life of the mother. The surgeon achieves the desired end differently in each case (she DOES something differently). In both cases the death of the baby (hysterectomy resulting in baby dying and evacuation of baby's brain resulting in baby dying) is unintended by the agent. In one case, however, when the surgeon says, "we couldn't save your baby," she means that she killed your baby. In the other case she means she did all she could, but the baby died as was foreseen. The moral distinction between the two is made in reference to the act itself.
A couple of things follow from the four criteria that we may grapple with personally.
The first is that sometimes we will have to allow an innocent mother to die because we are morally unable to kill the innocent baby trapped in her birth canal. While this is extremely tragic (as well as exceedingly rare) there are profoundly positive cultural implications to be obtained by affirming life not only in principle (thou shalt not kill - dignity of personhood, etc.) but also in act.
Second, the principle of double effect can work the other way in scenario 1, where the (consenting) mother can be operated on to save the baby, with the high probability that she will die during surgery. The case of Gianna Bretta Molla, an Italian pediatrian, is similar. She refused surgery to remove a large ovarian cyst during her pregnancy because it would result in the death of her child. She died shortly after giving birth in 1962.
Third, the intent itself is enough to vitiate a morally neutral or even good act. In the second scenario, for instance, if the surgeon performing the hysterectomy intends to kill the baby to save the mother, the surgeon IS morally guilty of killing the baby.
I enjoyed your comments. Let me know what you think of these.
