Double effect, all over again: The case of Sister Margaret McBride

Abstract

As media reports have made widely known, in November 2009, the ethics committee of St. Joseph's Hospital in Phoenix, Arizona, permitted the abortion of an eleven-week-old fetus in order to save the life of its mother. This woman was suffering from acute pulmonary hypertension, which her doctors judged would prove fatal for both her and her previable child. The ethics committee believed abortion to be permitted in this case under the so-called principle of double effect, but Thomas J. Olmsted, the bishop of Phoenix, disagreed with the committee and pronounced its chair, Sister Margaret McBride, excommunicated latae sententiae, "by the very commission of the act." In this article, I take the much discussed Phoenix case as an occasion to subject the principle of double effect to another round of philosophical scrutiny. In particular, I examine the third condition of the principle in its textbook formulation, namely, that the evil effect in question may not be the means to the good effect. My argument, in brief, is that the textbook formulation of the principle does not withstand philosophical scrutiny. Nevertheless, in the end, I do not claim that we should then "do away" with the principle altogether. Instead, we do well to understand it within the context of casuistry, the tradition of moral reasoning from which it issued.

Conscientious Objection in Healthcare: The Requirement of Justification, the Moral Threshold, and Military Refusals

“…9 The controversies concern both the very permissibility and possible justifications for this practice. Some authors suggest, contrary to the mainstream teaching, that direct abortion should be permissible by Catholic moral teaching because of the principle of choosing the lesser evil, which states that in a situation of choice between two or more evils (in this case, the death of one person or the death of two), one is obliged to perform the least wrong action (Prusak 2011;Sulmasy 2007). I have argued elsewhere that claims for conscientious exemption might only be justified by judgments that the representatives of a relevant tradition commonly recognize (Żuradzki 2016, see also Ciszewski 2021).…”

Law and childbirth in Ireland after the 8th Amendment: notes on women's legal consciousness

“…See, for example, Malak Thawley's case: Irish Times, '"Cascade of Negligence" Led to Pregnant Woman's Death' Irish Times, 12 January 2018, at <https://www.irishtimes.com/news/crime-and-law/courts/high-court/cascade-of-negligence-led-to-pregnantwoman-s-death-1.3353142>. so-called 'doctrine of double effect', 66 doctors may be reluctant to directly end fetal life, unless the woman's own life is at immediate risk. 67 Instead of ending a tubal ectopic pregnancy, they might wait to see if it ends spontaneously.…”

Conscientious Refusal of Abortion in Emergency Life-Threatening Circumstances and Contested Judgments of Conscience

“…Instead, AE may be understood differently (and, in fact, very often it is), even within the Catholic tradition or other moral doctrines that ascribe full personal status to fetuses. Many theologians or religious leaders have defended the moral permissibility of AE on the ground of either (i) the principle of double effect, as an indirect (and permissible within these doctrines) abortion where the intended aim is to remove not the fetus, but some biological material (e.g., a cancerous but gravid uterus or a placenta) that is treated as a real threat to the pregnant woman's life and also the cause of the fatal threat to the fetus (Lysaught 2011;Magill 2011); or (ii) the principle of choosing the lesser evil, which states that in a situation of choice between two or more evils (in this case, the death of one person or the death of two), one is obliged to perform the least wrong action (Prusak 2011). The Catholic tradition, surprisingly, has not reached a satisfactory consensus on this issue, and CO refusals in lifethreatening emergency circumstances are contested even within this normative doctrine (for a review of possible Catholic views on this issue, see Coleman 2013).…”