![]() ![]() One commonly made error is to misunderstand or dismiss entirely the distinction between intention and foresight another is to dismiss the relevance of intention to ethical evaluation of human acts in general. In making these errors, both opponents as well as proponents fail to articulate what the RDE is and what the appropriate contexts are in which the RDE may be effectively and helpfully employed. The RDE has also been misapplied or misunderstood, driven by several particularly significant errors in interpreting the RDE. ![]() Carbon monoxide only relieves pain by killing patients, which violates condition iii, above. While this defense may have been more credible had Kevorkian used morphine, his use of carbon monoxide cannot be justified by the RDE. Fieger argued that Kevorkian’s intent was to relieve suffering, not cause death. For example, Jack Kevorkian’s lawyer, Geoffrey Fieger, invoked double effect to defend Kevorkian as he was being charged with murder for euthanizing patients. Some of these abuses of the RDE border on deliberate deception. Though this case is widely accepted as a valid application, attempts have been made to stretch the application of the RDE beyond its scope. Applying the RDE, it is argued that the action of treating pain with morphine itself is good (or at least not objectionable), the relief of suffering, not death, is what is intended by the action of giving morphine, the possible death of the patient is not the means by which morphine achieves the good of relieving pain, and, given intense and severe pain and otherwise imminent death, there is a proportionately grave reason for permitting the risk of hastening death. The classic case for applying the RDE in medicine is the treatment of pain at the end of life when increasing doses of morphine may hasten death. There is a proportionately grave reason for permitting the bad effect.The good effect is not produced by the bad effect.The good effect, not the bad effect, is what is intended.The action itself is good or at least neutral.Traditionally, the RDE has been applied to justify actions that may produce a bad effect so long as the following conditions are met: It has also been argued that the RDE is not sufficiently grounded in a more general ethical theory. Intentions, these critics charge, are too difficult to determine. The formulation of the rule of double effect (RDE) and its application have been heavily debated in philosophy, theology, and bioethics throughout the last 50 years. Critics of the RDE have pointed to several weaknesses, including, most prominently, its reliance on intention to determine whether an act is right or wrong. We then offer examples where the RDE may be applied to ethically evaluate clinical practices and health policy initiatives. We also defend the importance of evaluating intention in making moral judgments and clarify the distinction between intention and foresight necessary for grounding the RDE. In this paper, we offer a reformulation of the RDE that establishes the preconditions that need to be met for the RDE to be appropriately applied. We argue that much of this controversy results from a history of misunderstanding or misapplication of the RDE. The formulation of the rule of double effect (RDE) and its application have been heavily debated in philosophy, theology, and bioethics throughout the last 50 years. ![]()
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