What is the principle of double effect in medical ethics?

From the Guidelines

The principle of double effect in medical ethics allows physicians to perform actions that may cause harm as a side effect when the primary intention is to do good, as long as the action itself is morally good or neutral, the good effect is directly intended, and the harm is merely foreseen. This principle is crucial in end-of-life care, palliative sedation, and certain pregnancy complications where treatments might indirectly risk fetal harm while saving the mother's life. According to the most recent and highest quality study, 1, the principle of double effect is a well-established concept that allows clinicians to prescribe potentially harmful medications or treatments if the intent is good, the harmful effect is not intended, and the potential benefit of the treatment outweighs the harms.

Key Conditions for the Principle of Double Effect

The principle of double effect is ethically justified if the following conditions are met:

• The action itself must be morally good or neutral
• The good effect must be directly intended while the harmful effect is merely foreseen
• The good effect cannot be achieved through the harmful effect
• There must be a proportionate reason for causing the harm

Application in Clinical Practice

Physicians apply the principle of double effect when they must balance competing ethical obligations, allowing them to prioritize patient benefit even when foreseeable but unintended negative consequences might occur. For example, administering high doses of morphine for severe pain in terminal patients may relieve suffering but could potentially hasten death through respiratory depression. As noted in 1, the rule of double effect holds that an action undertaken with the intent of achieving a benefit is morally acceptable even if it has a harmful side effect, provided that the harmful side effect is not intended, the side effect is not the cause of the benefit, and the benefit outweighs the harm.

Relevance to End-of-Life Care and Palliative Sedation

The principle of double effect is particularly relevant in end-of-life care and palliative sedation, where the goal is to relieve suffering and improve the patient's quality of life, even if it may indirectly hasten death. As discussed in 1, palliative sedation at the end of life, when nothing else has worked, with the goal of comfort during the dying process, can be employed using the doctrine of double effect. This principle allows clinicians to provide relief from refractory symptoms, such as dyspnea, while minimizing the risk of hastening death.

Conclusion is not allowed, so the answer will be ended here.

From the Research

Definition and Application of the Principle of Double Effect

• The principle of double effect is a guide for medical decision-making, allowing healthcare professionals to justify actions that have both positive and negative effects 2.
• This principle is often used in end-of-life decisions, where the goal is to relieve suffering while avoiding harm to the patient 3, 4.
• The principle states that an action with both good and bad effects can be justified if the bad effect is not intended, but rather a foreseen side-effect of the action 3.

Criticisms and Limitations of the Principle of Double Effect

• The principle of double effect has been criticized for being unreliable and controversial, with some arguing that it is not a sufficient guide for ethical decision-making in medicine 2.
• Others have argued that the principle fails to establish a morally relevant distinction between intended and foreseen effects, which can lead to inconsistent application in different situations 3.
• The principle has also been criticized for being used to justify hastening death, particularly in cases of palliative sedation and terminal extubation 4, 5.

Clinical Applications of the Principle of Double Effect

• The principle of double effect is commonly used to justify palliative sedation, a medical practice used to relieve refractory symptoms in patients at the end of life 5.
• It is also used to justify compassionate extubation, the withdrawal of life-sustaining treatment, particularly in cases where palliative sedation is pursued concurrently 5.
• However, some studies have suggested that the risk of hastening death through palliative sedation is more myth than fact, and that the principle of double effect may be used to perpetuate this myth 6.