Double Effect and Moral Relevance Curious Artifact or Bulwark

Many critics of Double Effect and even some of its proponents have focused on its Roman Catholic origins, questioning its moral relevance outside of absolutist Roman Catholicism (Boyle 1991a, 1991b; Quill, Dresser et al.). Indeed, this is the most common challenge articulated in the bioethics literature. What, then, can be said of the moral relevance of the PDE outside of absolutist Roman Catholicism? Should bioethicists outside of Roman Catholic moral tradition view the PDE as little more than the curious invention of sectarian casuistry?

To understand this challenge, it is important to highlight the fact that the Roman Catholic moral tradition, in which the PDE emerged, absolutely prohibits certain types or classes of action, including active euthanasia, abortion, murder, and suicide (Boyle, 1991b). In such a tradition, the question of appropriate act description and classification is of paramount importance. The intention condition of the PDE helps to delimit what counts as falling into a given class of action (recall Aquinas's claim, cited above, that the way an act is to be classified depends on intention). Provided an act does not fall into one of the absolutely forbidden classes of action, one may then apply the proportionate reason condition to help determine the permissibility of bringing about the evil effect. Thus, the moral relevance of the PDE and, in particular, of the intention/foresight distinction, is easy to establish in the context of Roman Catholicism with its absolute prohibitions on certain types of acts.

The claim that Double Effect is morally relevant only within the context of absolutist Roman Catholicism is highly problematic. As discussed above, the most fundamental element of the PDE is a conceptual distinction between intention and foresight. Arguably, the normative significance of any conceptual distinction will depend on the normative framework within which the distinction is operative (Aulisio, 1996, 1997). The central distinction of PDE, intention/foresight, is embedded in ordinary language and common morality, and is arguably important for certain areas of Anglo-American law despite its emphasis on individual autonomy (e.g., law of attempts, distinction between murder one and manslaughter; etc.) (Aulisio, 1996). More importantly, any moral framework, absolutist or not, that incorporates deontic constraints, formulated in terms of intention, on consequentialist considerations may have use of the intention/foresight distinction (and, therefore, the PDE) (Nagel; Kagan; Quinn, 1993; Beauchamp; Kamm, 2001).

If the preceding discussion is on target, given the wide variety of moral frameworks that incorporate deontic constraints formulated in terms of intention, it seems likely that the PDE will continue to be relevant to a range of bioethics issues. This does not mean that proponents of the PDE can rest easily, however. Serious challenges to the PDE remain. Chief among these are challenges to the conceptual tenability and practical applicability of the intention/foresight distinction, and the need for an adequate theory of intention to address these challenges. Though interesting and important in their own right, it seems unlikely that these matters will inhibit continued vigorous bioethics debate concerning the application of the PDE to vexing cases.

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