‘Doctor, you’ve got to help me. I’m in terrible pain and I know I’m dying. Put me out of my misery. Kill me swiftly and painlessly now. I can’t go on any longer.’
‘Let me get this straight,’ replied Dr Hyde. ‘Are you suggesting that I should, say, give you a very high dose of painkillers – 20mg of morphine sulphate perhaps – a dose so high that you would soon lose consciousness and shortly afterwards die?’
‘Yes! Please be merciful,’ said the patient.
‘I’m afraid that’s something I cannot do,’ replied Dr Hyde. ‘However, I can see that you are in pain, so here’s something I can do. In order to relieve your pain, I would need to give you a very high dose of painkillers, say 20mg of morphine sulphate, a dose so high, however, that you would soon lose consciousness and shortly afterwards die. How does that sound?’
‘Just like your first suggestion,’ replied the puzzled patient.
‘Oh, but there’s every difference in the world!’ replied the doctor. ‘My first suggestion was that I killed you, the second that I relieved your pain. I’m no murderer and euthanasia is illegal in our country.’
‘But either way I’m out of my misery,’ protested the patient.
‘Yes,’ said the doctor. ‘But only one way spares mine.’
Dr Hyde’s explanation of the difference between his two remarkably similar suggestions can appear to be mere sophistry, an attempt to give the patient what he wants while remaining within the confines of the law. For in many countries, such as Britain, it is illegal to shorten the life of a patient deliberately, even if they are in great distress and request it. However, it is permitted to take actions to reduce pain, even if it can be foreseen that this will hasten death. Intention therefore becomes the key. The same action – injecting 20mg of morphine sulphate – with the same consequences, can be legal if the intention is to relieve pain and illegal if the intention is to kill.
This is not just a strange by-product of the law. Behind the distinction is a very old principle of morality with its roots in Catholic theology. The principle of double effect states that it can be morally acceptable to do something in order to bring about a good, even if you can foresee that will also bring about something bad, as long as the intention is the good and not the bad consequence. The key is that to foresee is not the same as to intend, and it is intent that counts.
The principle can get a bad press because it looks like a way of justifying awkward moral choices. But if it is taken seriously, it is not obviously a sophistical get-out clause. For instance, we tend to assume that in the case of Dr Hyde, he really wants to give the patient his wish and is just seeking a way around the law. But we need to take seriously the possibility that Dr Hyde does not want to kill his patient at all. Nevertheless, he will reluctantly follow a course of action in pursuit of the noble cause of reducing suffering, even though he can see it will also lead to death. The difference between foresight and intent might be very important for how Dr Hyde views his own conscience.
The nagging doubt remains, however, that we are as responsible for what we foresee as we are for what we intend. If I start shooting my rifle into a forest, aware that I could easily kill a passer-by, it is no defence to say that, since killing people is not my intention, I’m off the moral hook if I accidentally shoot someone. If the principle of double effect is to be defensible, it has to explain why it too rules out such blatantly reckless behaviour.
See also
| 15. | Ordinary heroism |
| 29. | Life dependency |
| 71. | Life support |
| 89. | Kill and let di |