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Editor’s Note: This lesson on medical-moral issues is taken from the book Catholicism & Ethics. Please feel free to use the series for high schoolers or adults. We will continue to welcome your questions for the column as well. The email and postal addresses are given at the end of this column.

Special Course On Catholicism And Ethics (Pages 53-59)

All acts that have only morally good effects may be done, and acts which have only morally bad effects may not be done. But what do you do when faced with an action that has both a good effect and a bad effect? The answer can be found in what is known as the principle of the double effect. Before explaining this principle, some distinctions must be made.
The first distinction is that there are some actions that we will or intend, while there are others that we merely tolerate or permit. For example, a firefighter enters a burning building and wills to put out a fire. At the same time, he tolerates inhaling quantities of smoke. Or an Olympic athlete tolerates thousands of hours of grueling training with the intention of winning a gold medal. The same is true in the field of morality where some actions are intended, and others are merely tolerated.
The second distinction that must be kept in mind when considering the principle of double effect is that there is a difference between performing a good action which has both good and evil effects, and performing an evil action in order that good might come from it. For example, a state decides to build a new highway, which is a good thing, but forces people to move from their homes to make room for the highway, which is a bad thing. Or when the government decrees that all mentally ill persons must be killed in order to reduce costs and decrease taxes, the good effect results from the evil effect. The good effect of lowering taxes comes about only through the murder of thousands of innocent people.
When considering the principle of the double effect, there are four conditions which must be fulfilled. First, the action to be performed must be morally good in itself or at least morally neutral. Second, the good effect must not come about as a result of the evil effect but must come directly from the action itself. Third, the good effect must be willed, and the evil effect merely allowed or tolerated. Fourth, the good effect must be at least equivalent in importance to the evil effect. In other words, there must be a sufficient reason for permitting the evil effect to occur.
One classic example involves a pregnant woman with cancer of the uterus who is told by her doctor that an immediate operation (hysterectomy) is needed to save her life. The procedure, of course, will result in the death of the baby she is carrying because the child is not developed enough to survive outside the womb. So, the surgery will produce two effects: the good effect of saving the mother’s life and the evil effect of ending the baby’s life. Is the operation morally permissible?
Yes, under the principle of double effect. First, the action of removing a cancerous uterus is morally good. Second, the good effect of saving the mother’s life is a direct result of the surgery and not a result of the baby’s death. Third, the intention of the doctor is to save the mother’s life, not to kill the child. The death of the baby is an unintended side effect of the operation. Fourth, the saving of the mother’s life is at least equivalent to the baby’s death.
Now let’s look at an action which would not be permitted under the principle. A pregnant woman is suffering from persistent vomiting, which could be solved by aborting the child. However, such a solution is not morally permissible and violates double effect in the following ways:
First, the action is not morally good or even neutral; it is an evil attack on innocent human life. Second, the good effect, namely the health of the mother, follows from the evil effect. The mother is cured by the death of her child. Third, the evil effect is willed and not merely tolerated. Fourth, the death of the baby is not equivalent in importance to stopping the mother’s vomiting. It should be noted that persistent vomiting can be treated with hospitalization, the use of IV fluids, and anti-vomiting medications.
Here is another situation. A military officer orders the bombing of an enemy base knowing that there are civilians on the base and civilian families living nearby, some of whom will probably be killed in the air strike. Is the commanding officer’s order morally correct? Yes, according to the principle of double effect.
First, bombing a legitimate military target in wartime is not an evil action.
Second, the good effect of hastening the end of the war does not come about through the evil effect of killing innocent civilians.
Third, the commander wills only the destruction of a military target, not the death of the civilians.
Fourth, defending one’s own nation, or another country under attack, against an unjust aggressor in a just war is a sufficiently serious reason to permit the evil effect of some civilian deaths.
Or consider the case of a teenage girl who is confused about her sexuality and seeks radical surgery that would make her look like a boy. Is such surgery morally permissible under the double-effect principle? No.
First, the act of mutilating one’s body, except, for example, where amputating a diseased foot is necessary to preserve the health of the whole body, is never a morally good or neutral act.
Second, the good effect of making the girl feel better about her sexuality does not justify the evil effect of amputating her breasts.
Third, the evil effect is directly willed and not merely tolerated.
Fourth, the good effect of the girl’s peace of mind is not equivalent to the drastic mutilation of her body.
In fact, there is more and more evidence that those undergoing such surgery at a young age profoundly regret it later when they come to realize the life-altering effects of this mutilation.

Please Use The Word List Below To Answer The Questions (page 53-59)

ABORTION
DOUBLE EFFECT
EQUIVALENT
EVIL
GOOD
MUTILATION
REASON
TOLERATED
UTERUS
WILLING

Some moral questions can be solved by the principle of ________________.

We must distinguish between ________ an act or merely allowing it.

The action to be performed must be morally _________ or neutral in itself.

Removing a cancerous ________________ is a morally good act.

The good effect must not come about because of the _________ effect.

The good effect must be intended, and the bad effect must be only _________.

The good effect must be ________________ in importance to the evil effect.

______________ is always an evil attack on innocent human life.

There can be a sufficient ___________ to permit civilian deaths in a just war.

Bodily ____________ is not morally allowed in an effort to change one’s sex.

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Catholic Replies

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