PBA303H: Double-Effect Reasoning

Prerequisite: PBA203Y

FIXME double-effect reasoning is not a magic “principle”, not pixie dust that you can throw over a situation to get a moral answer. It's a method of reasoning about the moral object to navigate these situations.

  • Simple example: a mother cleaning her child's wound with alcohol that causes her child to scream out in pain1)
    • The child's pain is a direct result of her willful and direct actions
    • Yet we can see that her child's pain is not part of her moral object, that reason grasps the difference between the effects and the choice that's actually being made – to heal her child
    • This is double-effect reasoning, how we can understand the difference between the moral object and the effects when good and evil and intertwined
  • Classic example (even though it's incredibly rare): cancer in the uterus during pregnancy
    • First, you do everything you can to save both lives
    • But say you get to the extreme (and exceedingly rare) point where: if you do nothing, both will die; and no matter what you do, the child will die (pre-viable, etc.)
    • If you take an action, one effect will be good and the other evil
    • You start by proposing for yourself the moral object that you are going to choose, the most accurate descriptive of the choice: I'm going to remove the uterus to treat the life-threatening cancer that saves the only possible life that can be saved.
    • Now, double-effect reasoning helps you to test the moral object to make sure you're not playing word games with yourself to make it look like you're not doing evil
      1. Action itself must be good or indifferent (can't do evil)
        • this is not the moral object, otherwise you wouldn't need the other conditions
        • this means: you give the best most accurate attempt to propose what your choice will be, and then ask if that is good or indifferent
      2. Only the good effect is intended, the evil effect is foreseen but unintended (can't intend evil):
        • Am I only intending the good effect?
        • If I could save the child, I would. You've done everything possible (e.g. chemotherapy)
      3. The evil effect is not the means by which the good effect comes about (can't depend on evil):
        • Is the death of a pre-viable child the thing that cures cancer? No. Even if the child weren't in the uterus, you would still remove the uterus.
        • The death of the child is not what brings about the good effect.
      4. There is a proportionate reason for allowing the evil effect:
        • We are not talking about proportion between the evil and the good, e.g. whose life is more valuable, but rather the proportion between the choice you are making and the aim you claim to be achieving
        • Is the choice you are making is duly and justly proportionate to the aim you claim to achieving?
          • e.g. self-defence, if you're being attacked by a child whose just slapping at you and you pummel the child, that's not proportionate to the aim you're claiming to be achieving
          • If the aim is to save the only life you can through cancer, is removing the child who we cannot save proportionate? Yeah
          • Wrong: “you're pregnant and you have cancer, but no worries, we can remove the uterus”
            • Not proportionate, but using double-effect as a get out of jail free card – you haven't done everything you can to explore your options to save both lives
            • That doctor could not say the moral object of that case is simply to cure cancer
    • The removal of cancer was the direct action, and the removal of the pre-viable child was the indirect/nondirect action (even if you're the physically direct cause of the evil effect)
  • FIXME Ectopic pregnancy, Fr. Kevin Belgrave says double-effect reasoning breaks down and you just need to use your brain to focus on the moral object?

The Principle of Cooperation

This is just an application of double-effect reasoning.

  • Principle Moral Agent: The person doing the evil is the
  • Cooperator: The other person
  • Formal cooperation: when you, the cooperator, assent to the evil being done by the principle moral agent
    • Could be done at the level of moral object (where your aim is shared), or at the level of intention (where what you're doing isn't necessarily related but you agree with what they're doing)
      • e.g. boyfriend who counsels and pays for the abortion, even though he doesn't have an abortion
      • e.g. boyfriend says I don't agree, I think it's wrong, we shouldn't do this, but I'll drive you there (there's no other purpose that could be reasonable for driving to the abortion clinic) – complicit formal cooperation or immediate material cooperation, you say you don't want to cooperate but what you're doing serves no other purpose
  • Material cooperation
    • Immediate material cooperation: you can't do it, there's no other purpose whatsoever for your action but the evil
    • Mediate material cooperation: you don't intend or agree or assent to it, the act that your doing may even have its own independent goodness
      • May be licit, question is: how do you figure it out?
      • basically, when it meets the condition of double-effect reasoning
  • Examples
    • Librarian: access to all kinds of good books, but also some evil books
      • How close are we to the evil if someone checks out a book on IVF? Very far, e.g. David Boonin
  • Categories FIX from Sept 30 SAT3952H lecture, or rather guide
    1. How grave is the evil act of the principle agent?
    2. How close is your action to the evil?
    3. What reasons do you have for cooperating?
  • Preventing scandal and promoting a positive witness: these considerations alone could make an action immoral

Conscientious Objection

When you can't cooperate based on the application of double-effect reasoning.

  • Terms: Conscientious objections, conscious-based objections, conscious-based exemptions2)
  • One of the dangers is that we just think of this as some kind of “personal preference”
    • Julian Sevalescu (sp?): A doctor's conscience has no place in medical care, if doctors aren't wiling to provide legally available medical procedures, they shouldn't be doctors
    • Queen's University guy: The very idea that we should countenance conscientious objection in any profession is objectionable. No one forces anyone to enter any profession. It's like someone becoming a taxi driver and then objecting that cars produce pollution. No one forced you to become a taxi driver.
    • June 2016 10 point thing: Health care workers primary duty is to their patients, not to their personal conscience or personal moral values
  • Also the chaos argument: if we allow people to object to anything for any reason there will be chaos!
  • Important to understand
    1. Not a protection of personal preferences or opinions, but talking about a situation that touches the very moral integrity of a person
    2. It's not simply the integrity of the person that's at stake, as important as that is, but issues where conscience objection plays in concern fundamental and objectively grave matters not only for the individual but for the common good and integrity of the society
  • Referrals: “I don't kill people, but I know someone who does.”

Vital Conflicts

Situations in a pregnancy where the life or health of the mother or child is in question, and there's no clear answer that doesn't involve harm.

FIXME Thomas Murphy Goodwin, medicalizing abortion decisions (400-level)


  • cancer, e.g. uterine cancer
  • premature rupture of membrane (amniotic sac), risk of life threatening infection
  • placental eruption (detaches from the uterus)
  • preeclamcia, severe blood pressure that threatens both lives
  • pre-existing conditions
    • peripartum cardiomyopathy: if your heart already has trouble pumping blood, you've got to pump more blood pregnancy, so you're in trouble
    • pulminary aerterial hypertension
    • ectopic pregnancy

In same cases, the risk can be so extreme that it is impossible to save the life of the child, no matter what you do. And the only thing you can do brings you to an action that seems very similar to an abortion.

FIXME extreme cases are referred to as extreme vital conflicts (and Ronheimer's article is only about extreme vital conflicts, not about vital conflicts more generally)

The deliberate and direct killing of a human being is always wrong. Direct abortion, willed as an ends or a means, is always a serious moral evil. Double-effect reasoning does not seem precise enough.

Before viability, you have to have an extreme vital conflict before you can apply double-effect reasoning. We're talking about inducing labour here, not doing a surgical removal of the child (D&C).

After viability, you just need a proportionate reason that inducing labour is in the best interest of the child and the mother.

Uterine Cancer

Rare because young people rarely get cancer, and pregnant people are usually young. And rare because chemotherapy has advanced to the point where the child can tolerate chemotherapy just fine. If a child can endure a therapeutic program of chemotherapy, then you're just in a vital conflict, not an extreme vital conflict.

The first step is always: what can we do to save both?

If you have moral certainty that (a) there is no longer anything medical technology can offer, (b) the child is not viable, and © you cannot wait to viability otherwise both will die, then and only then does double-effect reasoning offer a way forward.

Ectopic Pregnancy

FIXME laptop notes

FIXME Q from a fellow pro-lifer, regarding a video that talks about how purposefully removing the baby too early (e.g. abortion pill) is still a form of killing the baby because you are purposefully putting the baby in a lethal environment. PL: “But this is exactly what we do when the mother's life is in danger - and early delivery - with every hope that the child will live, even though they often won't. And we do not consider this killing; rather it shows respect for life. How do we reconcile this comment with this post?” Maria: “in a life-threatening scenario like that, the child is no longer safe when inside the mother, either; so yes, you are moving her to an unsafe environment, but I don't think that is making her 'worse off', given that she was already in an unsafe environment. Consider two different scenarios: on a night with a crazy snowstorm, a mom and her infant are safely inside a warm house. She purposely puts the baby outside, and the baby freezes to death. I think we would all agree that that is a very immoral action and was a form of killing the baby. Now imagine the same scenario–mom and baby are in the house, crazy snowstorm outside, but then the house catches fire. The mother runs outside of the burning building with her baby, but the roads are so bad that the paramedics and firefighters don't get there for ages. By that time, the baby has died of exposure. In that second scenario, was she responsible for the baby's death? No; she and the baby left an imminently lethal environment, and then there just wasn't enough help in time to preserve the baby's life.”

From SAT3952H with Fr. Kevin Belgrave
Not just “what I won't do”, but at its heart, a positive contribution to the good of society, in saying that we as a society are better when we act in this way – not just an objection