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The Double Effect: In Theory and in Practice

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Abstract

It is not always possible to perform clinical interventions that benefit a patient without also triggering some degree of harm. The double effect (DE) is both a moral and pragmatic principle to determine whether the good outcome resulting from an action outweighs any detrimental secondary effects. The principle’s underpinnings are lodged in medieval, theological thought, and the continuing clinical significance of DE to a diverse, technological society is the subject of much debate among scientists and philosophers. In the scientific literature, DE is most often invoked to address questions of what is moral and ethical in end-of-life care.

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References

  1. Mangan J. An historical analysis of the principle of double effect. Theol Stud. 1949;10:41–61.

    Article  Google Scholar 

  2. Aquinas T. (13th c). Summa Theologica II-II, Q. 64, art. 7, “Of Killing”. In: Baumgarth WP, Richard J, Regan SJ, editors. On law, morality, and politics. Indianapolis/Cambridge: Hackett Publishing Co; 1988. p. 226–7.

    Google Scholar 

  3. Sulmasy DP. Killing and allowing to die: another look. J Law Med Ethics. 1998;26(1):55–64.

    Article  CAS  PubMed  Google Scholar 

  4. Shaw AB. Two challenges to the double effect doctrine: euthanasia and abortion. J Med Ethics. 2002;28(2):102–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Purdy L. Ending life [book review]. JAMA. 2006;295(7):830–1.

    CAS  Google Scholar 

  6. Tauber AI. Patient autonomy and the ethics of responsibility. Cambridge: MIT Press; 2005.

    Google Scholar 

  7. Quill TE, Dresser R, Brock DW. The rule of double effect – a critique of its role in end-of-life decision making. N Engl J Med. 1997;337(24):1768–71.

    Article  CAS  PubMed  Google Scholar 

  8. Carlet J, Thijs LG, Antonelli M, et al. Challenges in end-of-life care in the ICU. Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003. Intensive Care Med. 2004;30(5):770–84. Epub 2004 Apr 20.

    Article  PubMed  Google Scholar 

  9. McGee A. Double effect in the criminal code 1899 (QLD): a critical appraisal. QUT Law Just J. 2004;4(1):46–57.

    Google Scholar 

  10. Orentlicher D, Caplan A. The pain relief promotion Act of 1999: a serious threat to palliative care. JAMA. 2000;283(2):255–8.

    Article  CAS  PubMed  Google Scholar 

  11. Annas GJ. Congress, controlled substances, and physician-assisted suicide – elephants in mouseholes. N Engl J Med. 2006;354(10):1079–84.

    Article  CAS  PubMed  Google Scholar 

  12. Kapp MB. The U.S. Supreme court decision on assisted suicide and the prescription of pain medication: limit the celebration. J Opioid Manag. 2006;2(2):73–4.

    PubMed  Google Scholar 

  13. Vacco v. Quill, 117 S.Ct. 2293. 1997.

    Google Scholar 

  14. Washington v. Glucksberg, 117 S.Ct. 2258. 1997.

    Google Scholar 

  15. Quill TE, Meier DE. The big chill – inserting the DEA into end-of-life care. N Engl J Med. 2006;354(1):1–3.

    Article  CAS  PubMed  Google Scholar 

  16. Canick SM. Constitutional aspects of physician-assisted suicide after Lee v. Oregon. Am J Law Med. 1997;23(1):69–96.

    CAS  PubMed  Google Scholar 

  17. Reality check on the pain relief promotion act. Secretariat for Pro-Life Activities, United States Conference of Catholic Bishops, 3211 4th Street, N.E., Washington, DC 20017–1194 (202) 541–3070. http://www.nccbuscc.org/prolife/issues/euthanas/reality2.htm. Accessed 17 Aug 2006.

  18. Sykes N, Thorns A. The use of opioids and sedatives at the end of life. Lancet Oncol. 2003;4(5):312–8.

    Article  PubMed  Google Scholar 

  19. Fohr SA. The double effect of pain medication: separating myth from reality. J Palliat Med. 1998;1(4):315–28.

    Article  CAS  PubMed  Google Scholar 

  20. The use of opioids for the treatment of chronic pain: a consensus statement from American Academy of Pain Medicine and American Pain Society. Approved by the AAPM Board of Directors on 29 June 1996. Approved by the APS Executive Committee on 20 Aug 1996. http://www.ampainsoc.org/advocacy/opioids.htm. Accessed 19 July 2005. Under review.

  21. Farney RJ, Walker JM, Cloward TV, Rhondeau S. Sleep-disordered breathing associated with long-term opioid therapy. Chest. 2003;123(2):632–9.

    Article  PubMed  Google Scholar 

  22. Wang D, Teichtahl H, Drummer O, Goodman C, Cherry G, Cunnington D, Kronborg I. Central sleep apnea in stable methadone maintenance treatment patients. Chest. 2005;128(3):1348–56.

    Article  PubMed  Google Scholar 

  23. Webster LR, Grant BJB, Choi Y. Sleep apnea associated with methadone and benzodiazepine therapy [abstract]. Poster presented at the 22nd annual meeting of the American Academy of Pain Medicine (AAPM), San Diego, 2006.

    Google Scholar 

  24. White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction. 1999;94(7):961–72.

    Article  CAS  PubMed  Google Scholar 

  25. Santiago TV, Pugliese AC, Edelman NH. Control of breathing during methadone addiction. Am J Med. 1977;62(3):347–54.

    Article  CAS  PubMed  Google Scholar 

  26. Schwartz JK. The rule of double effect and its role in facilitating good end-of-life palliative care: a help or a hindrance? J Hosp Palliat Nurs. 2004;6(2):125–33.

    Article  Google Scholar 

  27. Snelling PC. Consequences count: against absolutism at the end of life. J Adv Nurs. 2004;46(4):350–7.

    Article  PubMed  Google Scholar 

  28. McIntyre A. Doctrine of double effect. In: Edward NZ, editors. The stanford encyclopedia of philosophy. Summer 2006 ed. 2006. http://plato.stanford.edu/archives/sum2006/entries/double-effect/. Accessed August 20, 2012.

  29. Patterson JR, Hodges MO. The rule of double effect [letter]. N Engl J Med. 1998;338(19):1389.

    Article  CAS  PubMed  Google Scholar 

  30. Cahana A. Is optimal pain relief always optimal? Bioethical considerations of interventional pain management at the end of life. Am Pain Soc Bull. 2002;12(3):1–4.

    Google Scholar 

  31. Webster LR. Methadone-related deaths. J Opioid Manag. 2005;1(4):211–7.

    PubMed  Google Scholar 

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Acknowledgment

Beth Dove of Dove Medical Communications, Salt Lake City, Utah, contributed technical writing and manuscript review. (Note: Please note the spelling of Dove – not Dover – Medical Communications).

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Correspondence to Lynn R. Webster M.D. .

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© 2015 American Academy of Pain Medicine

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Webster, L.R. (2015). The Double Effect: In Theory and in Practice. In: Deer, T., Leong, M., Ray, A. (eds) Treatment of Chronic Pain by Integrative Approaches. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1821-8_24

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  • DOI: https://doi.org/10.1007/978-1-4939-1821-8_24

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1820-1

  • Online ISBN: 978-1-4939-1821-8

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