The Doctrine of Double Effect (DDE) is often invoked to explain the permissibility of an individual’s action that has two outcomes: one where the end result can be foresee and is good, the other that can also be foresee and is bad (Goldworth, Amnon, 2008). In other words, this doctrine is used to justify cases such as where doctors give drugs to patients to relieve severe pain (good result) knowing that doing so may shorten their life span (bad result). Under DDE, this action is justifiable because the physician intention is not aiming directly at killing the patients.
The bad result of the patient’s death is a side effect of the good result of reducing the patient’s distressing pain. However, this doctrine is also a subject of controversy, and for some, an individual’s action that causes harm cannot be justified by its good effects (Foster et al., 2011). Thomas Scanlon claims that DDE is mistaken and that an action done with the aim of causing an innocent person’s death is always wrong (Lippert-Rasmussen, 2010). This paper will briefly summarize Scanlon’s view on the DDE, and discuss the scenario of organ shortage related to the article.
In the article, “Scanlon on the doctrine of double effect” (2010), the author suggests that Thomas Scanlon tries to narrow the problem of the natures of morality to judgements of right and wrong, and the reasons for accepting or rejecting such judgements. Scanlon’s critique of DDE is based on the analysis of permissibility, and the idea that an action may be permissible or not depends on the intentions of the agent, which is relevant to moral assessments of the way in which the agent deliberated the action.
Scanlon states that the intention with which one does a certain action makes a difference to its meaning, involving the significance of this action for the agent and others, and its meaning makes a difference to its permissibility (Lippert-Rasmussen, 2010). This point of view is applied in the evaluation of two pair of cases: tactical bomber and terror bomber; and drug shortage and organ shortage (Lippert-Rasmussen, 2010). Both pair of cases with potential moral relevant factors, except for the agents intentions that could inadvertently affect the comparison evaluation of either one as well as the interpretation of the DDE.
For example, in the case of Drug Shortage there are six patients dying from a treatable disease, medication is very limited, and five of them can be treated with a small amount of medicine unlike the sixth patient who will require all of it, which will cause the first five to die; therefore, the physician refrains from treating the sixth patient which results in the patient’s death, and instead treats the other five (Lippert-Rasmussen, 2010). In this case, the Doctrine of Double Effect is clearly demonstrated since using all of the medicine to save the five patients lives instead of just one is at least morally permissible. Meaning that the agent foresees the intention to save many as a good result, even though one will die as a side-effect of it. However, according to Foster et al. (2011), the intention/foresight distinction may not always be justifiable or at least easy to discern in all situations.
That is the case in Organ Shortage where six patients are dying because they are in need of organ transplants, the medicine available could cure only the sixth patient, but this patient happens to be organ-compatible with the rest of them; thus, the physician decides not to treat the sixth patient with the intention to save the other five (Lippert-Rasmussen, 2010). In this case, the DDE could be seen by its opponent as impermissible and morally problematic since the agent intends the death of one patient as a mean to save the other five. It might be tempting to explain the difference between these cases by saying that although it is permissible to let one die in order to save five, as in Drug Shortage, what is propose in Organ Shortage is to kill one in order to save the five, thus rendering the intention/foresight of the agent unethical and morally impermissible.
Based on these two case scenarios, we are more likely to agree with the action taken in Drug Shortage than the action taken in Organ Shortage. The reason being lays in the differences between the agents intention toward their patients. The intention/foresight of an action is directly relevant to moral and ethical assessment of an action. According to Goldworth (2008), the physician must satisfies the four criteria for DDE in order for an action to be considered morally permissible. Therefore, the action of letting someone died purposely, such is the case in Organ Shortage, so his or her organs can be utilize to save others does not meet the DDE criteria, since the bad effect and not the good effect is intended first. However, if we find ourselves in the physician’s predicament, it may be difficult to say what course of action should have been taken instead, without knowing the physician’s intention, and whether or not the physician has the ability to determine his or her own intention.
According to Lippert-Rasmussen (2010), Scanlon was torn between the strength of these set of opposing considerations and concedes that there is a difference in terms of moral permissibility between both cases. Scanlon believes that: If we have some obligation to a person so long as he is alive, the advantages of our being relieved of this obligation by his dying do not justify an exception to the principle requiring us not to kill that person, or to save that person’s life when we can easily do so (Lippert-Rasmussen, 2010). However, Scanlon does apply such exception to the case of Drug Shortage because the good effect is not produced by means of the patient’s death unlike in the Organ Shortage where the patient’s death is used as advantage to save the five others (Lippert-Rasmussen, 2010).
In conclusion, the Doctrine of Double Effect is concerned with the balance of goods and harms resulting from an action in relation to the agent’s intention. Although Scanlon suggests that an action aimed with the intention to cause harm to a person is always wrong and unjustifiable, the philosopher also concedes that there are certain cases where exception to this principle may apply. There is obviously an important moral difference between intentionally harming someone, and causing harm as a side-effect of a good intention such as shown in the case scenarios of Drug Shortage and Organ Shortage. Thus, this difference in the intention seems to be what explains the differences in moral evaluations and permissibility of an action.