Des Spence claims that, on the grounds of the Doctrine of Double Effect, doctors routinely engage in assisted dying: “The doctrine of double effect means that doctors give large doses of morphine near the end of life. We know that this will hasten death, but we square this moral circle by accepting that we are relieving suffering” (1). Spence then goes on to argue that we should just accept the principle of assisted dying: “Shouldn’t we be honest and accept the principle of assisted dying?” (1)

It has already been pointed out that talk of double effect is, in this context, misplaced on empirical grounds, since “There are no circumstances in which the prescription of a lethal dose of opioid is necessary to control suffering, and therefore there is no need to invoke the doctrine of double effect” (2). But there is another, possibly more general reason why talking of the doctrine of double effect here is problematic.

Spence moves directly from the supposed justification offered by double effect for death-inducing pain alleviation to the claim that we should then really also accept assisted dying. But that is a misunderstanding of the Doctrine of Double Effect: the all point of the Doctrine is that some prima facie morally wrong practices can, under certain conditions, be justifiable: namely if they are unintended side-effects of a morally worthy or beneficial endeavour. So applying the Doctrine of Double Effect to death-inducing pain alleviation does not mean endorsing assisted dying. It actually implies the very opposite, namely that such practice is not prima facie morally justifiable. Here one has clearly the alternative to just drop the Doctrine of Double Effect - which is the position I tend towards (3, 4) – but that option won’t help Spence’s argument, because if he drops the Doctrine of Double Effect then he loses his premise about death-inducing pain-alleviation. But if he keeps the Doctrine, then his argument no longer goes through.

References

(1) BMJ 2011;342:d3891

(2) BMJ 2011;343:d4512

(3) http://dx.doi.org/10.2139/ssrn.1930832

(4) http://ssrn.com/abstract=1997082

Competing interests: None declared