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Lesson 2 Norms of Morality, Principle of Double Effect and Proportionate Reason

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16 views8 pages

Lesson 2 Norms of Morality, Principle of Double Effect and Proportionate Reason

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© © All Rights Reserved
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At the end of the lesson, you are expected to:

• Explain the role of conscience and law as norms of morality


• Apply the principle of double effect in a concrete moral experience

IF I FOLLOW MY CONSCIENCE AND THE LAW

It’s not always easy to choose to do what is right, but if you listen to your conscience and
consult the law, you will usually know what choice you should make. For each of the
following items, describe the choice you should make. Include two additional temptations
you might face and the choice you should make in the face of each.

TEMPTATION MY CONSCIENCE TELLS ME THE LAW PROVIDES


My mom caught me in a lie. I
can lie again to cover up my
first lie.
My friends want me to help
them cheat on a test
The cashier at the store gave
me back an extra ten dollars
with my change.
My friends are spreading a
rumor about one of our
classmates.
I can download music for free
instead of buying the songs I
want.
My friend wants me to help
cover for her so she can go to
a party that her parents don’t
want her to go to.
My parents told me not to go to
a party that I really want to go
to. I can do it anyway; they’ll
never know.
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I found an expensive MP3
player in class. I think I know
who it belongs to, but I’d love
to just keep it for myself.

The Norms of Morality are the criteria of judgment about the sorts of person we ought
to be and the sorts of action we ought to perform. It refers to the quality of things manifesting
their conformity or non-conformity with the norm or criteria. (that which conforms is good
or moral, that which do not conform is evil or immoral)

The subjective norm of morality – Conscience


The objective norm of morality – Law (Natural)

CONSCIENCE

Conscience is the subjective/proximate norm


of morality. It is proximate because it is what directly
confronts an action as good or bad. Its functions are
to examine/investigate, to judge, to pass punishment
on our moral actions. It approves & commends;
reproaches & condemns; forbids & commands;
accuses & absolves.

Conscience is derived from the Latin words “con”


plus “scientia” which means “with knowledge” of what
is right or wrong or “trial of oneself” both in
accusation and in defense. It is the “inner or little
voice of God in man” crying out man’s moral
obligations and telling him what to do and what to
avoid in the moral order. It is an act of the practical
judgment of reason deciding upon an individual
action as good and to be performed or as evil and to be avoided.

According to Erich Fromm, conscience enables the person to know what ought to be
done in order to become his own self. Conscience becomes the reason why the human person
becomes aware of the goals of life, as well as the norms for the attainment of such goals.
Thomas Aquinas adds: “Man’s conscience is also responsible for making the human person
aware of the welfare and dignity of the other persons”.

Kinds of Conscience
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Antecedent Conscience judgment is passed before an action is
performed.

Consequent Conscience judgment is passed after an action is


performed.

Right/True Conscience judges what is really good as good and


what is really evil as evil according to the
true principles of morality.

Erroneous/ False Conscience judges what is really bad as good and vice
versa according to a false interpretation of
the moral principles.

Certain conscience a subjective assurance of the lawfulness


or unlawfulness of certain actions to be
done or to be omitted.

Doubtful conscience a vacillating conscience, which is unable to


form a definite judgment on a certain
action.

A doubtful conscience must first be


allowed to settle its doubts before an
action is performed.

Lax conscience is one which refuses to be bothered about


the distinction of good and evil.

It tends to follow the easy way and to find


excuses for omissions and mistakes.
These are people who act on the impulse of
“bahala na” on matters of morals.

Scrupulous conscience is a rigorous conscience, extremely afraid


of committing evil.

A scrupulous conscience is meticulous and


wants incontrovertible proofs before it
acts. It is frequently the result of a
stubborn character.
For some, it merely means a serious
concern about moral perfection.

One has the obligation to cultivate a true and certain conscience!

1) By studying and searching for truths in the laws and in the sciences. Overcoming
ignorance and error in moral matters.
2) Cultivating good habits. Overcoming doubts.
3) By militating against evil, condemning and fighting against it.
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4) One must learn how to use properly his/her freedom.

What causes erroneous conscience?

1. A mistake along the process of practical reasoning especially with regard to remote
conclusions of the moral principles.
2. Ignorance of law
3. Ignorance of the fact and other circumstances modifying human action.
4. Ignorance invoving future consequences, especially those dependent on the free will
of others.
LAW

It is an ordinance of reason directed towards


the common good and promulgated by the one who
has the care of the community or in authority.

Elements:

1) Ordinance/mandate – because it contains a decisive command to perform or to avoid


the performance of something.
2) Reasonable – a law should not be dictated by a despotic desire or momentary whim of
an authority. It must not be capricious, arbitrary, discriminatory and whimsical.
3) For the common good – means that that law should benefit all citizens and not the
exclusive benefit of some favored groups. it is the sum total of benefits derived by
individuals from the government and from the nation as a whole.
4) Promulgated – means the law must be officially published for the purpose of
informing the people. (published in Official gazette or newspaper of general
circulation)
5) Enacted by a competent authority – a person who is elected or appointed to make laws.
(Congress)

Kinds of Law

1) Eternal Law
• it is the Divine reason or the will of God commanding that the natural order of
things be preserved and forbidding that it be disturbed .
• it is the exemplar of Divine wisdom as directing all actions and movements.

Properties: Universal, Obligatory, Recognizable by Reason, Immutable
2) Natural Law
• it is man’s participation in the eternal law of God.
• it is an extension of the divine order of things as apprehended by human reason.
• are not written decrees; figuratively speaking, they are “written in the hearts of
men.” They are impressed in human nature by the author of nature.
• it refers to the nature of all created things which is the principle of movements
and action: chemical, biological, psychological, or rational.
• it is recognized by all men regardless of creed, race, culture, historical
circumstances.
• All agreed that there is an inner force that compels man towards good and away
from evil.”

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Properties: Universal, Obligatory, Recognizable by Reason, Immutable
3) Human Positive Law
• are the laws which proceed from a properly constituted authority such as the
state or the church.
• this serve to supplement the provisions of the natural law in view of the special
needs of the community.

Properties:
• A human law should be in accord with the divine law.
• A human law should be in accord with the natural law.
• A human law must promote the common good.
• A human law must have a universal character.

Read the following case scenarios first:


1) Mrs. Griffin recently discovered that she had an ectopic pregnancy—the embryo was
implanted in her fallopian tube. Her physician admitted her to a Catholic medical center
for treatment and scheduled a salpingostomy (a surgery that makes an incision in the
fallopian tube through which the embryo is removed). But an ethics-savvy surgery
center nurse questioned whether that procedure was morally permissible given the
Catholic identity of the hospital. The nurse called the bioethics committee to inquire
whether the doctor should perform a salpingectomy (surgical removal of the fallopian
tube) instead, fearing that the Catholic Church considers a salpingostomy to be a direct
abortion.

2) Mr. Smith has advanced metastatic liver cancer with neoplasms in his bones that
cause excruciating pain. He has built up tolerance for virtually all pain medications;
his doctors believe that one of the few remaining ways to alleviate his pain is to sedate
him. Mr. Smith has said that he no longer wants any curative treatments. The Catholic
hospital in which Mr. Smith is receiving care has a strong stance against euthanasia
and physician-assisted suicide. Members of Mr. Smith family approach his doctors and
unanimously request, "Please end his life so he can stop suffering."

What morally viable options are available for the patients and health care professionals?

Principle of Double Effect

The history of the principle of double effect dates at least as


far back as the work of St. Thomas Aquinas. Although St. Thomas
did not use the term "double effect" or refer to the principle, he
used the concept in justifying killing in self-defense [1]. In so doing,
he recognized the bad effect (death of the assailant) and the good
effect (preservation of the victim's life). Can one justifiably kill an
attacker to save his or her life? St. Thomas answered in the
affirmative. Likewise those who use the principle of double effect

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today attempt to discern the rightness or wrongness of actions that will have both good and
bad (evil) effects.

To make such a determination, one must analyze an action on the basis of four
conditions; all of which must be met for the action to be morally justifiable. The conditions of
the principle of double effect are the following:
1) The act-in-itself cannot be morally wrong or intrinsically evil.
2) The bad effect cannot cause the good effect.
3) The agent cannot intend the bad effect.
4) The bad effect cannot outweigh the good effect; there is a proportionate reason to
tolerate the bad effect.

In analyzing acts within the framework of the four conditions, one considers that, if the
act satisfies the four conditions, then the act is indirect and, therefore, morally licit. If,
however, the act does not fulfill these four conditions (or, according to some interpretations,
just the first two conditions) the act is direct and, therefore, the act is not morally licit. Some
argue in fact that the first three conditions are three statements of the same moral
proposition: the act cannot be intrinsically evil.

Let’s go back to the case scenarios and try to see how the principle of double effect
works.

1) In Mrs. Griffin’s case, a traditional application of the principle indicates that


salpingostomies are direct abortions whereas salpingectomies are indirect abortions.
This conclusion is not without controversy, especially given the development of
salpingostomy as the standard of care for ectopic pregnancy. Salpingostomy "directly"
attacks the developing embryo, so it does not satisfy the first condition.
• A surgeon performing a salpingectomy, however, removes the pathological tissue
(fallopian tube), which does fulfill the first condition.
• The death of the embryo does not cause, in and of itself, the good effect—preservation
of the mother's life; it is the removal of the pathological tissue that causes the good
effect, thus fulfilling condition 2.
• The agent (physician or mother who consents to the procedure) does not intend the
death of the embryo, but rather intends the cure of the ailment, thus fulfilling condition
3.
• The last condition, whether there is a proportionate reason to tolerate the unintended
bad effect, asks if the good effect (preserving the life of the mother) outweighs the bad
effects—death of the embryo, and, incidentally with salpingectomy, reduction or
elimination of the mother's fertility. Proportionate reason will be discussed more
thoroughly below.

2) In Mr. Smith’s case, a traditional application of the principle of double effect indicates that
one can administer pain medicine even if the patient's death is a foreseen, unintended
consequence. How is this justifiable? Is this not euthanasia?
• Here, the administration of pain or sedative medicine is not, in and of itself, morally
wrong (fulfilling condition 1).
• The death of Mr. Smith, were it to happen, does not cause his relief of pain (fulfilling
condition 2)—the sedative medicine accomplishes this.
• The agent, the physician or Mr. Smith 's surrogate decision maker, does not intend on
the death of Mr. Smith (fulfilling condition 3).

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• This last statement may seem to contradict the statement provided by the patient's
family. Nevertheless, a close examination of the intent behind their statement is his
relief from suffering caused by his pain. Arguably, Mr. Smith's family sees his death as
the only means to achieve this end or is unable to distinguish between pain relief and
death. Again, is there a proportionate reason for tolerating the bad outcome that would
permit sedating Mr. Smith?

Proportionate Reason

Proportionate reason grounds the fourth condition of


the principle of double effect. How does one determine
whether the good effect outweighs the bad effect? The
phrasing of this question is immediately problematic.
One of the main critiques of proportionate reason is its
mathematical connotation: how can a good effect outweigh a bad effect, especially in end-of-
life decisions where the bad effect is often death? Proportionate reason is a moral principle
that one may employ to determine objectively and concretely the rightness or wrongness of
actions.
One should not understand proportionate reason in purely mathematical terms, but
rather as a balance between values and disvalues in determining whether the means (an act)
is proportionate to the intended end or reason. The "reason" (ratio) here is not "some serious
reason" that an agent identifies to justify the evil effect of the act; alternatively, what many
commentators "mean by 'reason' is a concrete value which is at stake in the act of an agent".
The term "proportionate" means a formal relation between the reason for the act and the
premoral values and disvalues in the act.
In terms of our cases, one sees that proportionate reason exists in both.
1) In Mrs. Griffin's case, one may claim that a salpingectomy fulfills the fourth condition
because the good effect (preservation of her life) outweighs the bad effect (death of the
embryo). Because the means (removal of pathological tissue) is indirectly ending the early
life of the embryo, such means are proportionate to the intended end; there is a non-
contradiction between the means and the end. What about a salpingostomy? Or
administering methotrexate? The permissibility of salpingostomy requires a re-
interpretation of the act in question and a determination of whether it passes the first two
conditions. Is a salpingostomy a direct abortion?

2) In Mr. Smith 's case, one may argue that terminal sedation fulfills the fourth condition
because the good effect (relief of pain) outweighs the bad effect (death of Mr. Smith). Here,
the means (palliative sedation) is proportionate to the end (relief from pain) insofar as it
is the last remaining option. The question of alternatives can help physicians and
surrogate decision makers discern what the true intentions behind certain requests are.
Thus, a physician might ask Mr. Smith 's decision maker, "If there were any other way to
relieve Mr. Smith of his pain, would you want to pursue that option?" If he or she answers
yes, then one can claim that his or her intent is not in the death of Mr. Smith, but relief of
Mr. Smith 's pain. The agent cannot intend both to cause the patient's death and relieve his
pain. In this hypothetical case, if there are no alternatives to relieving his pain except for
sedating him, there is a proportionate reason to do so, and such an act is not euthanasia
(direct killing of Mr. Smith).

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CASE STUDY
Ms. Richards was a 50-year-old woman followed by oncology for her widely metastatic
lung cancer. Her disease was refractory to treatment and progressed; she grew weaker.
She chose comfort-focused care and refused further cytotoxic therapy. Extensive osseous
involvement began to cause her excruciating bone pain at multiple sites, and the pain
progressed despite several courses of palliative radiation therapy, bisphosphonates, and
increasing doses of opioids and co-analgesic medications. She was dyspneic and anxious,
with both symptoms aggravated by her severe pain. She was admitted to a local hospital for
general decline, dehydration, and severe pain. Increasing doses of intermittent intravenous
morphine were administered with suboptimal effect, and 2 days after admission, a
continuous morphine infusion with prn clinician-administered boluses was ordered. After
aggressive dose titration, at last, the patient seemed to achieve an acceptable level of
comfort and calm. She remained intermittently awake and interacted with family at her
bedside, but some of the staff was uncomfortable administering increasingly high doses of
opioid, fearing that they would hasten the patient’s death.
Are these nurses ethically justified in giving very high doses of opioids for pain
at the end of life?
Instruction: Analyze the case and answer the question above applying the principle of double
effect.

The Norms of Morality are the criteria of judgment about the sorts of person
we ought to be and the sorts of action we ought to perform.
Conscience, the subjective norm of morality, functions to examine/investigate,
to judge, to pass punishment on our moral actions. It approves & commends;
reproaches & condemns; forbids & commands; accuses & absolves.
Law, the objective norm of morality, is an ordinance of reason directed towards
the common good and promulgated by the one who has the care of the
community or in authority.
The doctrine (or principle) of double effect is often invoked to explain the
permissibility of an action that causes a serious harm, such as the death of a
human being, as a side effect of promoting some good end. According to the
principle of double effect, sometimes it is permissible to cause a harm as a side
effect (or “double effect”) of bringing about a good result even though it would
not be permissible to cause such a harm as a means to bringing about the same
good end.

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