-
Chapter 3. Decisions by Competent Patients
- Georgetown University Press
- Chapter
- Additional Information
16 Chapter 2 drug that the dose needed to eliminate pain will suppress respiration and thus be a causal factor in their death, but it is still morally right and legal to use that needed dosage. It is certainly a moral act to relieve pain, and this sort of medication cannot be considered ethically wrong, as long as consideration is given to the patient’s wishes. The Catholic tradition tends to call this third kind of action indirect killing. To understand this, it is necessary to introduce the principle of double effect. From a theoretical perspective, there are a number of serious problems with the PDE, but those problems do not directly affect its application to the issue of pain relief and so we can be brief. The principle of double effect claims to answer the following question: Is it right to perform an action from which two or more effects result, some of which are good and may rightly be intended and some of which are bad and may not rightly be intended? The principle proposes that an action with both good and bad effects is right if and only if all four of the following conditions are met: (1) the act-in-itself must not be morally wrong, (2) the bad effect must not cause the good effect, (3) the agent must not intend the bad effect, and (4) the bad effect must not outweigh the good effect. The use of medication to relieve pain in a dying patient even at the foreseen risk of hastening death meets the requirements of the PDE. Indeed, it is sometimes called double-effect euthanasia, a term that is better not used because of the confusion it causes. Pain relief that hastens death meets the first condition of the PDE because the act itself is not a killing but an administration of medication that relieves pain. It meets the second because the bad effect, death, is not caused by the good effect, pain relief. Rather, the medication causes both with equal causal immediacy. Third, the intention of the agent is not that the patient be dead but that the patient be free of pain. And fourth, in the case of a dying patient, the bad effect, a slightly earlier death, is outweighed by the good effect, the relief of pain. Thus this action, like the first two, may well be morally right according to Catholic moral tradition. And in the U.S. legal and ethical consensus, the same judgment is made. Killing and Allowing to Die 17 This means that it is always medically possible, and, assuming the proper decision maker agrees, it is always morally right and always legal to eliminate physical pain in the imminently dying patient . It is extremely important to stress this, because some claim that there are exceptions, that is, that there are cases in which complete pain relief is not possible even for an imminently dying person . But if we look more closely at the reasons for this claim, we find that none of them are valid. The three most commonly cited arguments for why elimination of pain in a dying patient is not always possible are as follows. First, there is fear of addiction. I am glad to say that in the past few years, whenever I have mentioned this, listeners have laughed. And it is indeed laughable. Addiction is certainly an important problem for those whose unwarranted use of drugs causes harm to their lives and the lives of others. Heroin, cocaine, alcohol, nicotine, and other agents, including drugs such as morphine used by doctors for pain relief, can cause great damage when they are improperly used. For an imminently dying patient, however, pain medication is not addictive in this sense. The term addiction indicates both a description of a physical condition (withdrawal causes physical symptoms) and a social condition. In this latter sense, addiction is a social construct. It connotes crime, violence, the need for rehabilitation , and so on. None of these are present in the imminently dying patient. A person dying of cancer on a morphine drip is unlikely to go out and rob a liquor store for a fix. Recent medical literature has claimed that even physical addiction is very rare in people who need opiates for pain relief. Even the nondying person is unlikely to become physically addicted to a drug given for relief of pain. Usually, when the source of the pain is ended, the drugs are ended, too...