Tag: double effect

The Fallacy of Incommensurability

"if there’s even one life that can be saved, then we’ve got an obligation to try."

"If there's anything we can do to save even one life… we should do that."

"One life lost on the job is one too many."

"If even one innocent person would be convicted, that's too many."

Frequently in speech about policies pertinent to human life and safety, one hears absolute claims such as the above. The true principle that "one may not do evil that good may come," is transformed into the seemingly plausible, but false principle "one must do everything possible to prevent such-and-such evil [e.g., innocent human death]". The plausibility of this principle derives from the fact that human life is, in a sense, of infinite value, so it seems that the loss of innocent human life can never be weighed up and considered as an altogether acceptable risk.

President Obama has on several occasions invoked such a principle to justify his positions. He even gives the impression that he actually believes the principle is valid, which would be a strong indication that he is quite incompetent to lead any community, let alone a country.

It is hard to know how genuinely any politician holds such a principle, since it seems to have settled so deeply into popular consciousness that it may be difficult for a politician to truthfully and rationally justify such decisions without risking being widely regarded as inhuman and inconsiderate. Imagine a politician publicly stating something like the following:

"This health-care legislation could be expected to save 1000 lives per year, but it would cost 12 billion dollars per year, and would a burden for doctors and other medical professionals; it's not worth it."

In actual fact, it is quite impossible to apply this principle consistently in practice, and attempting to do so leads to many contradictions. In almost every case, one of the things one could do to prevent certain bad things from happening would be to refrain from certain actions one is purportedly obliged to do in order to hinder other bad things.

Imagine, for example, that a city is deliberating whether to build a bridge over a large river. As the situation stands at present, 10,000 persons are driving daily on average 40 miles to work and back; with the new bridge, they would only need to drive an average of 20 miles. The construction of the bridge is expected to cost 20,000,000 dollars, and is estimated to have an 85% chance of involving at least one fatality for a construction work, and probably several.

Given that at least one death is expected in the construction of the bridge, it seems the city must forbid its construction. On the other hand, by constructing the bridge, 100,000,000 miles less would need to be driven per year, which over just ten years would save 15 lives. So, according to the principle that if something can be done to save even one life, one is obliged to do it, the city must build the bridge.

What will someone do who pretends or thinks that he abides by this principle of incommensurability? Who thinks that, because human life has a kind of infinite value, one can never consider an expected loss of human life to be an acceptable consequence of some policy? Faced by such a dilemma, he will either choose randomly, or in accordance with personal or basic human prejudices.  Most frequently, he will be inclined to over-rate probable and proximate events, and under-rate large but improbable and remote events. In the case of the bridge construction, he will likely underrate the importance of the deaths in traffic accidents that would be avoided by building the bridge, and overrate the importance of the deaths involved in the construction of the bridge.

Are Quick and Slow Death Different?

In the post The Principle of Double Effect and Abortion, or more precisely, in a comment on the post, the example was given, taken from Steven Long, of two persons in a space capsule with a limited air supply. There would be enough air for one of the persons to reach earth safely, but not for both. Moreover, one person is mortally allergic to an anti-viral agent in the air, and so will die in any case. The question was raised, can the other person deny him air by ejecting him from the spaceship?

I would like to compare this case with a analogous case inspired by my last post. Two persons are on a island with just barely enough water for one person. Again, one person is allergic to something in the water, and will die in three to four weeks if he drinks it–whereas he will die in one to two weeks if he does not. Can the other person deny him water, by force if necessary, or is this murder?

Steven Long asks, apparently, rhetorically, "By moving him, do we not in fact hasten his death? If we deliberately hasten the death of another—and let us suppose we do so against his will—do we not then commit murder?" I think in terms of people's instincts, it makes a tremendous difference how much the death of another person is hastened by our action, that ejecting someone from a spaceship, where he will die immediately, is much more revolting and instinctively wrong (at least to persons who are not in that situation; I would not be surprised to find that the moral instincts of persons on both sides who were actually in such a situation were much less strongly against this action) than denying a person water that is anyway poisonous to him, and thus shortening his life span from about three weeks to one week.

Is this right? Are your instinctive judgments regarding the two cases the same or different? Is denying someone water that would kill him anyway over a space of three weeks seem instinctively the same or different than denying him air that would kill him over a space of one week?

The Mistake of Expecting Moral Systems to Resolve All Cases

Aquinas points out that while the first principle of natural law, "good is to be done and pursued and evil to be avoided", is most certain, the more concrete and particular the principles and situations at which one looks, the less great is the certainty that can be attained. Consequently, anyone who sets out to develop or expound a moral system that will enable him to objectively judge every moral case with certainty, is sure to fail in this mistake: either there will be cases that cannot be judged with clarity by the system, or there will be cases that are misjudged by it. The following series of situations may serve as an illustration of inevitability of "grey" cases.

1. A mother is stranded with her child, aged 10, on an island, has no way to contact anyone off the island, and no way to procure additional fresh water. She knows that people will be arriving by boat in four weeks, as the island is a scheduled and never missed stop on a cruise. There is enough water for her child to survive four weeks, though getting somewhat dehydrated. She refrains from drinking any of the water, so that she can give it all to her child, though she knows she is morally certainty to die herself.

2. Ten adults are stranded with ten children in a similar situation. The adults all go without water for the sake of the children, and die of thirst.

3. Twenty adults are stranded on the island. Ten volunteer to give their share of the water to the others.

4. Twenty adults are stranded on the island, with adequate fresh water for all of them for 18 days. Thus, if they all drink a normal share of the water, they may well not all die, but will all run a serious risk of death. Five of them therefore volunteer to give up their share of water, and are thus virtually certain to die.

5. The same situation as four, with the additional remark that those who volunteer to give up their water persons with incurable cancer who expect to die within a few years, and so consider a greater chance of survival for the healthy and younger persons worth giving up their own chance of survival for.

6. The same situation as five, except that there is adequate fresh water for everyone for a little more than 20 days, so that if everyone drinks their share of water, the risk of death for each individual is relatively low, around 0.5%.

7. The same situation as six, except that the persons who give up their water are persons suffering from a disease that will kill them within two months in any event, and causes them constant and great pain, and this horrible pain and short life span plays a significant role in their decision to volunteer to give up their water.

It is quite clear, in the first three cases, that the persons who give up their water are not guilty of suicide either directly or indirectly, that is, either by reason of their intention (they will to die), or by reason of the objective character of their choice. (By "objective character" I mean that theoretically, it might be that giving up the water only makes sense if someone considers his life of no value, and is basically throwing it away; but this is clearly not the case in the first three examples.)

In the last case, if the risk of death given that everyone drinks water is low enough, and if the painfulness of the people's lives plays a great enough role in their deliberation, it is clear that their decision to give up drinking water is suicidal in its very intention. Similarly the sixth case is clearly suicidal in fact, if not in intention, and is morally wrong.

There is, however, a continuum between the first cases and the last cases–a continuum both in regard to the greatness of the risk of other people's death avoided by giving up one's own water, and in regard to the shortness of life and greatness of pain that makes one less concerned to preserve one's own life.

Consequently, it is impossible to make a system that will enable one to objectively judge every such decision as objectively right or objectively wrong. One might say that "if a person in giving up their water is objectively treating their life as though it were of no value, the decision to give up their water is wrong," but there will be cases in which it is unclear whether giving up their water is "treating their life as if it were of no value."

The Principle of Double Effect and Abortion

Some time ago I posted on the principle of double effect, and mentioned cases of conflict that are not evidently resolvable by the principle of double effect, at least not in its usual sense. There is also a problem applying the principle of double effect to resolve an issue or dispute, if the very point in question is whether a given effect can or should be considered as an effect, that is, as a circumstance of the action, or whether it must be considered as a defining aspect of the object.

For example, when a live baby is delivered by the induction of labor or C-section before it is mature enough to live for long outside the womb, is the death of the child an effect of the action, so that it could fall under the principle of double effect, or does the action morally need to be described as the direct killing of an innocent child?

A discussion arose recently about the case in Phoenix, where a nun at a Catholic hospital approved an abortion that was considered medically necessary to save the mother's life, and when there was (apparently) not considered to be any reasonable hope of her carrying the child until viability. The bishop of the diocese of Phoenix declared the nun who approved the abortion to have been automatically excommunicated by her action.

The diocesan's Q and A on the situation (PDF) says, "If a necessary treatment brings about the death of the child indirectly it may be allowable. A Dilation and Curettage (D&C) or Dilation and Extraction (D&E), however, would never be such a treatment since it is the direct killing of the unborn child and is, morally speaking, an abortion." This suggest that such a procedure may have been done at the hospital. I have been unable to verify the facts on this question. But suppose that the abortion was carried out by C-section, delivered a live baby, who died hours or days later because it was as yet too immature to live outside the mother's womb. Would that change the situation?

The doctrinal commission of the USCCB's statement on this case, as well as the USCCB's Ethical and Religious Directives for Catholic Health Care Services (5th edition, 2009, PDF), seem to imply that it would not alter the situation morally. The ethical and religious directives say "Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended   destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion." The doctrinal comission's comment on this is: "Direct abortion is never morally permissible. One may never directly kill an innocent human being, no matter what the reason." In other words, it considers any "directly intended termination of pregnancy before viability" to be, morally speaking, the "direct killing of an innocent human being," even when physically it is indirect, as when a live baby is delivered before viability.

The same thing seems to be taught by a statement of the Holy Office:

Dr. Titius, when called to a pregnant woman, who was very ill, observed repeatedly that the only cause of her deadly disease was her pregnancy, i. e., the presence of a fetus in her womb. Hence there was but one way open to him to save the patient from certain and imminent death, namely, to cause abortion. On this course he usually decided in similar cases, taking care, however, to avail himself of such remedies and operations which would not of themselves, or not immediately kill the fetus in the womb, but, on the contrary, would, if possible, deliver the child alive, although, not being able to live, it would die soon afterward. But after reading a rescript from the Holy See to the Archbishop of Cambrai, dated August 19, 1888, that it was unsafe to teach the lawfulness of any operation which might directly kill the fetus, even though such were necessary to save the mother, Dr. Titius began to doubt the lawfulness of the surgical operation by which he had not unfrequently caused abortion to save pregnant women who were very ill.

Therefore, in order to set his conscience at rest, Dr. T. humbly asks whether, on recurrence of the like circumstances, he may resort to the aforesaid operations.

Response:

To this urgent request the Cardinals of the Holy Roman Congregation of the General Inquisition, after advising with the theological consultors, have decided to answer: No; according to other decrees, namely, those of May 28, 1884, and of August 19, 1888…. (Response of the Holy Office to the Archbishop of Cambrai, July 24, 1895; AAS 28, 383ff., Denzinger, n. 3298)

More related statements of the Catholic Church on Abortion

In response to the argument that the death of the child that is consequent upon delivery of the child is an effect of the delivery, and thus the delivery of a child through induction of labor or C-section before viability may fall under the principle of double effect, when without such an operation both mother and child will die, the position taken by the Holy Office at that time (the CDF has been curiously silent on the question in the past forty years in its various statement on procured abortion, respect for life, etc.) and by the USCCB seems to amount to: one may not consider the principle of double effect applicable; one must consider the death of the child as an essential, determining aspect of the act of delivering the child.

I must admit, I am quite at a loss as to the logic that could be behind the position of the Holy Office and the USCCB (Dear readers, HELP!), and wish that the CDF would make a statement on the issue, either to say that this earlier decision of the Holy Office (assuming I'm rightly interpreting it) is correct, or that it is incorrect or misunderstood or not applicable, or that the question is an open one: the silence I find distressing, particular in view of the wide gap that seems to be present between the views of Catholic doctors and the views of many bishops.

The Principle of Double Effect

Some philosophers, such as Peter Knauer, have argued that the principle of double effect is the "fundamental principle of ethics." I would argue that this position is overstated, but that nonetheless, an analogous extension of the principle of double effect might correctly be called the fundamental principle of ethical "problems." How so? The truly fundamental principle of moral action is "do good and avoid evil." And so the fundamental moral "problem" to be encountered and dealt with, is the twofoldness of an action, when an action has something good and something bad about it.

The principle of the double effect is usually traced back to Thomas Aquinas, but its modern formulation derives from Cajetan and others. The principle is usually articulated along the following lines: an act with two effects, one good and bad, is a morally good action if:
(1) the act is in itself good or at least indifferent;
(2) the agent intends the good effect, and does not intend the bad effect, neither as an end, nor as the means to the good effect;
(3) the bad effect is not in fact the means to the good effect;
(4) the goodness of the good effect sufficiently outweigh the badness of the bad effect.

So basically, the "principle of double effect" is an articulation of how the basic principle "do good and avoid evil" is to be applied in certain situations of conflict between some good and some evil.

Extension of the principle

There are other situations of conflict between some good and some evil that arise in human life, which do not seem to be resolvable by the principle of double effect, at least not if causes, effects, means, end, etc., are taken in their ordinary sense.

Some examples of such problems:

(1) A spouse must make a decision whether to have marital intercourse with a spouse who engages in contraception.

(2) A married priest (a Catholic Eastern Rite priest, or an Orthodox priest), learns through a confession he hears, that his wife was actually already married to another man, and so his marriage with her is invalid.

(3) A judge in the highest court of the land has weighty personal or private reasons indicating that an accused person is innocent, yet all the public evidence is decidedly against that person.

(4) Doctors must decide whether to make an experiment aimed at discerning the effectiveness of a drug, an experiment whose effectiveness depends upon the use of placebos, and thus upon not giving the drug to many persons who would benefit from it, if it is in fact beneficial.

(5) An agent who expects his imminent capture by the enemy considers deliberately making himself drunk, so that he will be entirely unable to give information about a code, even under torture. (The code is so complex he would not be able to explain it in a drunken state).

These problems cannot be straightforwardly resolved by recourse to the principle of double effect, at least not in its normal modern formulation. Still, if any general principle can be formulated to resolve them, such a principle will be somewhat like the principle of double effect, i.e., based upon a comparison of the conditions of the good and bad aspects of the act.

I will return to this issue in later posts.