Morphine vs. ABT-594: A Reexamination by the Principle of Double Effect

National Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, No. 61 (Washington. DC: United States Catholic Conference, 1995): 23.

Preston Thomas “Killing Pain. Ending Life,” The New York Times, 1 November 1994, A-15. Preston, a cardiologist and professor of medicine at the University of Washington clarifies his position by stating: “the morphine drip differs from the popular conception of euthanasia in two ways. The first is time. If a physician injects a patient with a highly lethal drug (or a sudden large dose of a drug like morphine), death ensues within seconds and any observer brands the act as euthanasia. A morphine drip takes time, and hospital staff and family come and go during the process. Death is gradual and appears to be of natural causes, and the doctor's absence at the time of death dispels any association between physician and dying. The second difference is stated intent. Physicians, wanting to ease their patient's suffering and not wanting to be identified as the agents of death, act within the boundaries of normal medical practice. But any form of suffering can be interpreted as pain, and assessment of severity is a matter of professional judgment. If I administer morphine to a suffering and dying patient to relieve pain, I am legal and ethical; if I say it is to end her life, I am illegal and unethical.” Ibid.

“Poison from Frog Skin Leads to a Painkiller,” The New York Times, 2 January 1998, A-11.

Joseph T. , Mangan S.J. “An Historical Analysis of the Principle of Double Effect,” Theological Studies, 10 (March, 1949): 41.

Joseph T. , Mangan S.J. Mangan uses the story of Eleazar in the sixth chapter of the First Book of Machabees to prove this point. “When the Jews were at war with a hostile king, one of the Jews, Eleazar, the son of Saura, performed a very brave deed. He noticed that one of the elephants in the ranks of the enemy was harnessed with the king's harness. Moreover, this elephant was taller than the others and it seemed to Eleazar that the king was on it. Therefore, Eleazar decided to risk the danger of fighting alone through the ranks around the king in order to destroy him. Fighting furiously against the enemy and killing them right and left, he finally reached the elephant. His only hope of bringing down the beast lay on his going between the massive legs and cutting through the tough hide with deadly sword thrusts. This he did, foreseeing that the elephant's fall would kill him too. This brave deed is one of the scriptural deeds justifiable under the principle of double effect.” Ibid., 42.

Joseph T. , Mangan S.J. , 43; see also Tom Beauchamp and James F. Childress, Principles of Biomedical Ethics 3rd edition (New York: Oxford University Press, 1989), 185, note 15.

James F. , Keenan S.J. “The Function of the Principle of Double Effect,” Theological Studies, 54 (1993): 299; see also Josef Ghoos, “L'Acte à double effet: Etude de théologie positive,” Ephemerides Theologicae Lovanienses 27 (1951): 30-52.

The four conditions of the principle of double effect formulated by Gury state: “1) The ultimate end of the author must be good, that is, the author may not intend the evil effect… 2) The cause itself of the effects must be good or at least indifferent, that is, as an act the cause must not be opposed to any law …3) The evil effect must not be the means to the good effect… 4) There must be a proportionately serious reason for actuating the cause, so that the author of the action would not be obliged by any virtue to omit the action.” See J.P. Gury, Compendium Theologaiae Moralis, “De actibus humanis,” c. 2, 9 (New York: Benzinger, 1874). For further analysis on the historical development of the principle of double effect, see Christopher Kaczor, “Double-Effect Reasoning From Jean Pierre Gury to Peter Knauer,” Theological Studies, 59 (1998): 297-316; Thomas Cavanagh, “Aquinas’ Account of Double effect,” Thomist 61 (1997): 107-121: Mangan 59-60: and Richard M. Gula, Reason Informed by Faith: Foundations of Catholic Morality (New York: Paulist Press, 1989). 270.

Gerald Kelly S.J. Medico-Moral Problems, (St. Louis, MO: The Catholic Hospital Association of the United States and Canada, 1958), 13–14.

For a more detailed description of the proportionalist's argument, see Keenan, 301-302; Peter Knauer, “La détermination du bien et du mal moral par le principe de double effet.” Nouvelle Revue Théologique 87 (1965): 356-76; Haig Katchadourian, “Is the Principle of Double Effect Morally Acceptable?” International Philosophical Quarterly 27 (1988): 21-30; L. Cornerotte, Loi morale, valeurs humaines et situations de conflit,” Nouvelle Revue Théologique 100 (1978): 502-532; Bernard Hoose, Proportionalism: The American Debate and Its European Roots (Washington, DC: Georgetown University Press, 1987); Schüller Bruno , “The Double Effect in Catholic Thought: A Reevaluation,” in Doing Evil to Achieve Good, eds. McCormick Richard , and Ramsey Paul (Chicago. IL: Loyola University Press, 1978), 165-191: and Richard McCormick, S.J., Notes on Moral Theology: 1965 Through 1980 (Washington, DC: University Press of America, 1981), 751-756.

Pius XII “Address to Delegates to the Ninth National Congress of the Italian Society of the Science of Anesthetics,” Acta Apostolicae Sedis 49 (February 24, 1957), 147.

Congregation for the Doctrine of the Faith, “Declaration on Euthanasia,” (Washington, DC: United States Catholic Conference, 1980): 3.

Keenan , 305–306

Berkow Robert . M.D., ed. The Merck Manual of Diagnosis and Therapy, 16th ed. (Rahway, NJ: Merck Research Laboratories, 1992), 1409–1410.

Berkow Robert . M.D., ed. The Merck Manual of Diagnosis and Therapy, 16th ed. (Rahway, NJ: Merck Research Laboratories, 1992), 1410.

Campi Christine Walker “When Dying is as Hard as Birth,” The New York Times, 5 January 1998, A-19.

Strauss Evelyn “New Nonopioid Painkiller Shows Promise in Animal Tests,” Science 279 (January 2, 1998): 32.

Bannon A.W. , Decker M.W. “Broad-Spectrum, Non-Opioid Analgesic Activity by Selective Modulation of Neuronal Nicotinic Acetylcholine Receptors,” Science 279 (January 2, 1998): 78.

Strauss , 33.

At this writing, Abbott Laboratories believes that early indications of ABT-594's effectiveness ought to come when the first results from the European safety trials become available. For more details, see Strauss, 33.

Walter James J. “Proportionate Reason and Its Three Levels of Inquiry: Structuring the Ongoing Debate,” Louvain Studies 10 (Spring, 1984): 32.

McCormick's criteria for proportionate reason first appeared in Richard McCormick, Ambiguity in Moral Choice (Milwaukee, WI: Marquette University Press, 1973). He later reworked the criteria in response to criticism of this criteria. His revised criteria can be found in Doing Evil to Achieve Good, 751-756.