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Ethical Principles: The Principle of Double Effect

The principle of double effect, sometimes referred to as “the rule of double effect” is a comprehensive guideline often applied in various fields in making ethically controversial decisions that are permissible to human beings and with the supreme purpose of achieving the most ethical ultimate good and equally withstanding the foreseeable bad to be encountered. In trying to pursue the ultimate possible good, the principle of double effect requires that such a pursuit should neither employ the bad as a means to achieve the good nor pursue the good with the knowledge that there will be a direct negative consequence as a result of pursuing the good. Instead, if at all cost the bad cannot be done away with, then the pursuant of the good should in itself be good and should only indirectly or unintentionally result in the bad (Ashley et al, 1997 and Cataldo, 1995).

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Application of the PDE: A case in the end of stage pancreatic cancer

Dr, Robinson is in the quagmire of whether to administer morphine to his patient, Mr. Mills who is suffering from “end-stage pancreatic cancer” and is in great pain. If the medical physician decides to administer the drug, it will lessen the patients pain, but at the same time hasten patients death”. If the doctor decides not to administer morphine, his patient will continue grieving in pain, though his death will not be hastened. The principle of double effect requires that certain conditions be met, that is, the action considered by the doctor should be in itself ethically good, there should be no direct or intended cause of the bad, the bad should not act as means to achieving the good and finally, the good should be proportionate to the bad (Cataldo, 1995). Suppose the physician has to apply this principle, he would consider administering morphine. In doing so, his intention will not intentionally be to accelerate the patients death but to lessen the pain of his patient despite reducing his lifespan. Reducing the pain is the good that comes with hastened death that is deemed ethically permissible.

The possible ethical dilemmas encountered in this scenario

The principle of double effect is characterized by a number of substantial controversies, precisely questioning practicability of the conditions set my ethicists regarding this principle. The first condition to be met is that complementing the principle of autonomy. The second condition complements the principle of nonmalfeasance; the third condition is on the principle of beneficence and finally, there is the principle of justice (Davensport, 1997 and Jonsen, & Winslade, 1992). Autonomy in this context implies Mr. Mills has a right to decide what is to be done on his body and medical physician has to respect such a decision supposedly made by an adult of sound mind. Principle of nonmalfeasance requires that the doctor should do no harm to his patient. Principle of beneficence requires that the doctor has a duty to do good for his patient, and lastly, the principle of justice is concerned with proportionality in decision making (Davensport, 1997).

Considering the above highlighted conditions set by ethicists in the principle of double effect, the principle of beneficence seems to be in support of Dr. Robinson, as it allows him to administer the drug with the purpose of pursuing the ultimate good for his patient. Principle of beneficence as applied in this scenario is in the sense that doctor Robinson would not have caused any direct or intentional bad to the patient, but only good which in itself ethically permissible. On the other hand, the principle of autonomy may bar the doctor from administering morphine in case the decision of the patient contradicts that of the doctor to do so. Autonomy here implies the patient has a right to reject inject of any drug into his body, and the medical practitioner has to respect such a sound decision even if it will do more harm than good to the patient (Jonsen, & Winslade, 1992). After all, it’s patients decision and not the doctors.

Position taken regarding this issue

One of the conditions to be met by Dr.Robinson for the principle of double effect to be considered ethically permissible in this scenario is that the doctor should not use the bad as a way of acquiring the good. For instance, the physician may not choose to do away with injection of morphine even if he knows it would speed up patients death. Suppose not administering the morphine is to be his decision, it would contradict his responsibility of doing good to the patient as required by principle of beneficence. The patient will continue grieving in pain and still die in the long ran anyway. By administering morphine to Mr. Mills, he is relieved of the great pain he is experiencing, so that even if he has to die of “the end stage pancreatic cancer”, he will die under less pain.


Ashley et al. Health-Care Ethics: Theological Analysis of Ethical principles”. 4th Edition. Washington, DC: Georgetown University Press. 191-95.1997.

Cataldo, P. “Ethical Principles of Medicine: The Principle of the Double Effect”. Journal of Medicine and Philosophy. 1995.

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Davensport, J. Ethical Principles of practice in Clinical Settings. Vol 1. The Permanente Journal. Kaiser Permanente.1997.

Jonsen, A.R. & Winslade, W.J. “Clinical ethics and the practical approach to ethical decisions in clinical medicine”. 3rd Edition. New York: McGraw-Hill.1992.

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