Intended for healthcare professionals

Editorials When doctors might kill their patients

The moral character of clinicians or the best interests of patients?

BMJ 1999; 318 doi: (Published 29 May 1999) Cite this as: BMJ 1999;318:1432

Intention alone cannot determine the morality of actions

  1. Len Doyal, Professor of medical ethics
  1. St Bartholomew's and the Royal London School of Medicine and Dentistry, London E1 2AD

    Following the acquittal of an English doctor, Dr David Moor, who had given a dying patient a lethal dose of diamorphine, we invited tw ethicists to debate the issue at the centre of the case: that of giving a drug with the intention of relieving suffering even though it may hasten death. Professor Raanan Gillon argues that the difference between intending and foreseeing is all important, while Professor Le Doyal argues that the effect of this is to raise the moral character of a clinician above the best interests of his or her patients

    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 …

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