The Double Effect: In Theory and in Practice

Abstract

It is not always possible to perform clinical interventions that benefit a patient without also triggering some degree of harm. The double effect (DE) is both a moral and pragmatic principle to determine whether the good outcome resulting from an action outweighs any detrimental secondary effects. The principle's underpinnings are lodged in medieval, theological thought, and the continuing clinical significance of DE to a diverse, technological society is the subject of much debate among scientists and philosophers. In the scientific literature, DE is most often invoked to address questions of what is moral and ethical in end-of-life care. The following discussion will trace the principle's beginnings, its usual clinical applications, and the areas where DE is most subject to differing interpretations. Reaching beyond the end-of-life debate, the analysis will turn to decisions that must be made while caring for patients who suffer chronic, nonmalignant pain. The question remains open as to whether the arguments raised serve to nullify, modify, or only reinforce the strictures of DE principle, in part or in whole. (PsycINFO Database Record (c) 2016 APA, all rights reserved)