Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-25T09:39:16.672Z Has data issue: false hasContentIssue false
  • English
  • Français

Relieving Pain and Foreseeing Death: A Paradox About Accountability and Blame

Published online by Cambridge University Press:  01 January 2021

Susana Nuccetelli  and
Gary Seay
Get access Rights & Permissions [Opens in a new window]

Extract

In a familiar moral dilemma faced by physicians who care for the dying, some patients who are within days or hours of death may experience suffering in a degree that cannot be relieved by ordinary levels of analgesia. In such cases, it may sometimes be possible to honor a competent patient's request for pain relief only by giving an injection of narcotics in a dosage so large that the patient's death is thereby hastened. Doctors rightly worry that taking an action likely to result in a patient's death may violate the Hippocratic injunction against the direct killing of anyone in their care.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 28 , Issue 1 , Spring 2000 , pp. 19 - 25
Copyright
Copyright © American Society of Law, Medicine and Ethics 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Whether it is in fact the morphine that kills has been questioned (Kolata, G., “When Morphine Fails to Kill,” New York Times, July 23, 1997, at B10). But this unresolved empirical matter does not affect our argument.Google Scholar
In the Hippocratic Oath, the physician swears, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect” and “I will keep [the sick] from harm and injustice….”Google Scholar
Throughout, “harm” refers to injurious deprivations such as loss of life, health, property, or privacy, and we draw no distinction between duties and obligations.Google Scholar
In contemporary discussions, some versions of what we here call “the Doctrine of Double Effect” have been defended by Grisez, G., “Toward a Consistent Natural-Law Ethics of Killing,” The American Journal of Jurisprudence, 15 (1970): 64–96; and Devine, P., The Ethics of Homicide (Ithaca: Cornell University Press, 1978), at 106–33, among others. See also Foot, P., “Morality, Action, and Outcome,” in Honderich, T., ed., Morality and Objectivity (London: Routledge & Kegan Paul, 1985); and Quinn, W.S., “Actions, Intentions, and Consequences: The Doctrine of Double Effect,” Philosophy and Public Affairs, 18 (1989): 334–51.Google Scholar
Foot, P., “The Problem of Abortion and the Doctrine of Double Effect,” The Oxford Review, 5 (1967): 5–15.Google Scholar
This version, suggested by Quinn (supra note 4, at 334), is sufficient for our purposes here, and it is what we shall mean by “the Doctrine of Double Effect.”Google Scholar
Hart, H.L.A., “Intention and Punishment,” The Oxford Review, 4 Hilary (1967): 5–22.Google Scholar
The case is, for instance, in Bennett, J., “Morality and Consequences,” in McMurrin, S.M., ed., The Tanner Lectures on Human Values (Cambridge: Cambridge University Press, 1980); and in his The Act Itself (Oxford: Clarendon Press, 1995): At 194–225. See also Quinn, supra note 4; and Bratman, M., Intention, Plans, and Practical Reason (Cambridge, MA: Harvard University Press, 1987): At 139–64.Google Scholar
This is a notorious problem for the theory when applied to certain cases of abortion to save the mother's life. See Kuhse, H., The Sanctity of Life Doctrine in Medicine: A Critique (Oxford: Clarendon Press, 1987): At 94–5.Google Scholar
We of course leave open the possibility that it is justified in some other way. It might, for example, be doubted whether death is a harm in the envisioned case, in view of the alternative. See Beauchamp, T.L. Childress, J.F., Principles of Biomedical Ethics, 4th Ed. (New York: Oxford University Press, 1994): At 28, 210, 233.Google Scholar
Similarly, Bentham, J., in Introduction to the Principles of Morals and Legislation [1789] (New York: Hafner, 1946), distinguishes between consequences that are “immediately intended” (either as end or as means) and those that are only “obliquely intended” (i.e., foreseen as likely).Google Scholar
Kuhse, supra note 9.Google Scholar
Williams, G., The Sanctity of Life and the Criminal Law (New York: Alfred Knopf, 1970): At 203.Google Scholar
Hart, H.L.A., “Are There Any Natural Rights?” Philosophical Review, 64 (1955): 175–91.CrossRefGoogle Scholar
Feldman, R., “Epistemic Obligations,” in Tomberlin, J., ed., Philosophical Perspectives (Atascadero, CA: Ridgeview, 1988): At 235–56. See also Stocker M., “‘Ought’ and ‘Can,’” Australasian Journal of Philosophy, 49 (1971): 303–16.Google Scholar
For a different view on this, see Stocker, supra note 15; and Kekes, J., “‘Ought’ Implies ‘Can’ and Two Kinds of Morality,” Philosophical Quarterly, 34 (1984): 460–67.Google Scholar
See, for example, Kass, L., “Neither for Love nor Money: Why Doctors Must Not Kill,” Public Interest, 94 (1989): 25–46; and Pellegrino, E., “Doctors Must Not Kill,” in Misbin, R., ed., Euthanasia: The Good of the Patient, the Good of Society (Frederick, MD: University Publishing Group, 1992): At 27–41. See also Gaylin, W. Kass, L. Pellegrino, E. Siegler, M., “Doctors Must Not Kill,” JAMA, 259 (1988), 14: 2139–40; and Baumrin, B., “Physican, Stay thy Hand!” in Battin, M. Rhodes, R. Silvers, A., eds., Physician Assisted Suicide: Expanding the Debate (New York: Routledge, 1998): At 177–81.Google Scholar
See, for example, Kamm, F.M., “Physician-Assisted Suicide, Euthanasia, and Intending Death,” in Battin, , supra note 17: At 28–62. See also Williams, G. supra note 13; and Rachels, J., The End of Life: Euthanasia and Morality (Oxford: Oxford University Press, 1986); and Beauchamp Childress, supra note 10.Google Scholar
See, for example, Chisholm, R., Person and Object (LaSalle, IL: Open Court, 1976): At 74–75; Harman, G., “Rational Action and the Extent of Intentions,” Social Theory and Practice, 9 (1983): 123–41; and Bratman, M. supra note 8: At 139–64.Google Scholar