Principle of Double Effect

QUOTE

Hippocrates once said…

“First, do no harm.”

(Greek physician and philosopher)

CONCEPT

Principle of Double Effect

The Principle of Double Effect is a moral and ethical guideline that addresses situations where an action has both a positive intended effect and a negative unintended side effect.

Originating from the writings of Thomas Aquinas, the principle states that it is morally permissible to perform such an action if it meets specific criteria: the action itself is good or morally neutral; the good effect is intended, not the bad effect; the good effect is not achieved by means of the bad effect; and there is a proportionately serious reason for allowing the bad effect.

This principle is often applied in fields like medicine and ethics, helping individuals navigate complex decisions where benefits and harms must be carefully weighed.

STORY

One … or None?

In August 2000, the world was captivated by the harrowing case of conjoined twins known publicly as Jodie and Mary (pseudonyms to protect their identities).

Born in Manchester, England, the twins were joined at the lower abdomen. Jodie was the stronger twin with a functioning heart and lungs, while Mary relied entirely on Jodie's circulatory system for survival. Doctors determined that without surgical intervention, both would die within months.

However, if they performed a separation surgery, Jodie had a high chance of survival, but Mary would die immediately.

Their parents faced an unimaginable dilemma. "We cannot agree to kill one of our daughters to save the other," they declared, refusing consent for the operation based on their religious and moral beliefs. The hospital, believing it was their duty to save Jodie, sought legal permission to proceed without parental consent.

The case escalated to the British Court of Appeal, igniting intense ethical and legal debates. After much deliberation, the court ruled in favor of the surgery.

They concluded that the operation was lawful because the primary intention was to save Jodie, not to harm Mary. The death of Mary was an unintended but foreseen side effect—a tragic consequence overshadowed by the imperative to save at least one life.

On November 7, 2000, the separation surgery was performed.

As expected, Mary died shortly after the procedure due to her inability to survive independently. Jodie survived and, over time, grew into a healthy child. The parents, while grieving the loss of Mary, accepted the outcome, though the emotional and ethical complexities lingered.

This real-life drama exemplifies the Principle of Double Effect. The surgeons' primary aim was to save Jodie—a morally good action. Mary's death was neither intended nor used as a means to achieve this end but was an unavoidable side effect of the life-saving procedure.

The good effect (saving Jodie) did not result from the bad effect (Mary's death), and there was a proportionately grave reason to proceed: the imminent death of both twins if no action was taken.