Don’t Blame Me! The role and scope of the principle of ‘Double Effect’ Jonathan Montgomery 13 July 2012

The problem Interventions have (or may have) multiple effects We want some of these but not others Are we responsible for the undesirable effects? When does the good we do justify the harm?

distinctions Motive/intention/purpose/desire –Foreseeability Act /omission –Duties to act Causation/responsibility

Do you need it? Consequentialist? –May not add anything to the calculations Virtue based? –May not help Principalist? –Non-maleficence? Defining its scope Thou shalt not kill? –Rights based? –Vitalist?

The ‘Doctrine’ Good or at least neutral action –independently of consequences You intend only the good effect –More like ‘motive’ The bad effect not means to the good –otherwise ‘intended’ The good effect outweighs bad on –‘proportionality’ ‘sufficient reason’

An Alternative ‘Defence of Necessity’ where you 1.Need to act to avoid irreparable harm 2.Do no more than is necessary to avoid it 3.Evil inflicted is not disproportionate to the evil avoided

R v Arthur 1981 'holding operation, in the nature of setting conditions where the child could... if it contracted pneumonia... or if it revealed any other organic defect die peacefully'  'a positive act…which was likely to kill the child... accompanied by an intent on his part that it should as a result of the treatment that he prescribed die'

Re A Conjoined twins: ‘Jodie and Mary’ ‘Best interests’ –J would promote interests by saving life –M not in her interests (although one judge thought in her interests to be allowed to die) –Choice between two deaths and one? –Separating twins is least detrimental option ‘Self defence’ (M threatening J)

R v Adams 1957 Pain relieving drugs that also shorten life may be used if the patient is close to death (causation?) their use is ‘right and proper’ care the purpose is to relieve pain not shorten life (motive/intention)