The ethics of side effects: Sanctity of life and doctrine of double effect as political rhetoric

This paper provides a critical theoretical examination of the moral and legal problems and possibilities associated with euthanasia and assisted suicide. The paper accepts that there are compelling moral objections to legalising intentional killing of patients by doctors, because this involves a judgment that the patient's life is no longer worth living. However, it also argues that euthanasia and assisted suicide may be nevertheless justified on the basis that it need not necessarily involve intentional killing in a moral or legal sense. The paper argues that intention is not merely a common sense concept referring to a doctor's purpose, but is rather a more complex moral concept. In many legal jurisdictions where a person commits an act knowing that it will also have fatal consequences, these are sometimes treated as intended and culpable. On the other hand, sometimes the foreseen fatal consequences of an act are treated as merely foreseen and the person is not punished. The difference between the two situations is that in the first, the actor's purpose is deemed to be unworthy of justification (e.g. where a doctor gives an elderly patient a lethal morphine overdose in order to inherit her wealth), where-as in the second it warrants justification (the morphine dose was necessary to manage the patient's pain). This paper argues that the medical care at the end of life should also be approached in this manner: i.e. if the doctor's primary purpose is moral in itself (i.e, he wants to alleviate the patient's suffering, to respect the patient's dignity and autonomy) then the fatal consequences of that purpose should be treated as justified, even if this means prescribing a lethal drug or administering a lethal injection. By adopting such an approach, it is possible to build a moral defence of assisted dying.