The moral character of clinicians or the best interests of patients?BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7196.1432 (Published 29 May 1999) Cite this as: BMJ 1999;318:1432
Intention alone cannot determine the morality of actions
- Len Doyal, Professor of medical ethics
- St Bartholomew's and the Royal London School of Medicine and Dentistry, London E1 2AD
In the aftermath of Dr David Moor's acquittal for murder, the doctrine of “double effect” has been given a good hearing. In the eyes of its proponents this formulation offers a way out of the moral dilemmas that often arise when patients die as a result of medical ministrations. The argument is that such deaths are morally acceptable if the intervention which led to them was designed for another acceptable purpose. That is to say, we can—and should—differentiate between good consequences (such as the relief of pain) which are intended and bad consequences (such as death) which are foreseeable but not intended.
If the double effect argument is accepted, then the morality—and indeed the identity—of a particular action should be judged on the original intent of the clinician concerned and not on any “collateral damage” that might ensue. This is …