Theoretical Medicine and Bioethics

, Volume 32, Issue 4, pp 271–283 | Cite as

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

  • Bernard G. PrusakEmail author


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.


Double effect Casuistry Catholic hospitals Ethical and religious directives for Catholic healthcare institutions Abortion Principle of choosing the lesser evil 



I thank Lydia Moland and Peter Clark for discussions on this article and two anonymous reviewers for constructive criticisms of an earlier draft.


  1. 1.
    Haggerty, Barbara Bradley. 2010. Nun excommunicated for allowing abortion. National Public Radio, May 19. Accessed April 10, 2011.
  2. 2.
    The Arizona Republic. 2010. Statements from the Diocese of Phoenix and St. Joseph’s. May 15. Accessed April 10, 2011.
  3. 3.
    Pope John Paul II. 1995. Evangelium vitae. Accessed April 10, 2011.
  4. 4.
    Committee on Doctrine of the United States Conference of Catholic Bishops. 2001. Ethical and religious directives for Catholic healthcare institutions. 4th ed. USCCB. Accessed April 10, 2011.
  5. 5.
    Catechism of the Roman Catholic Church. 1997. 2nd ed. Washington, DC: United States Conference of Catholic Bishops. Accessed April 10, 2011.
  6. 6.
    Ehrlich, John. 2010. Abortion performed at St. Joseph’s Hospital. Respect for Life Newsletter, Diocese of Phoenix 1(1).Google Scholar
  7. 7.
    Kaczor, Christopher. 1998. Double-effect reasoning from Jean Pierre Gury to Peter Knauer. Theological Studies 59: 297–316.Google Scholar
  8. 8.
    Boyle, Joseph M. Jr. 1980. Toward understanding the principle of double effect. Ethics 90: 527–538.CrossRefGoogle Scholar
  9. 9.
    Mangan, Joseph T., S.J. 1949. An historical analysis of the principle of double effect. Theological Studies 10: 41–61.Google Scholar
  10. 10.
    Committee on Doctrine of the United States Conference of Catholic Bishops. 2010. The distinction between direct abortion and legitimate medical procedures. June 23. Accessed April 10, 2011.
  11. 11.
    Grisez, Germain G. 1970. Toward a consistent natural-law ethics of killing. The American Journal of Jurisprudence 15: 64–96.Google Scholar
  12. 12.
    Cavanaugh, T.A. 2006. Double-effect reasoning: Doing good and avoiding evil. Oxford: Oxford University Press.Google Scholar
  13. 13.
    Donagan, Alan. 1977. The theory of morality. Chicago: University of Chicago Press.Google Scholar
  14. 14.
    Goodstein, Laura. 2010. Arizona: Hospital loses Catholic affiliation. New York Times. December 22. Accessed April 10, 2011.
  15. 15.
    Keenan, James F., S.J. 1993. The function of the double effect principle. Theological Studies 54: 294–315.Google Scholar
  16. 16.
    Knauer, Peter, S.J. 1965. La détermination du bien et du mal moral par le principe du double effet. Nouvelle Revue Théologique 87: 356–376.Google Scholar
  17. 17.
    McIntyre, Alison. 2001. Doing away with double effect. Ethics 111: 219–255.CrossRefGoogle Scholar
  18. 18.
    Boyle, Joseph M. Jr. 1991. Who is entitled to double effect? Journal of Medicine and Philosophy 16: 475–494.Google Scholar
  19. 19.
    Sulmasy, Daniel P. 2007. “Reinventing” the rule of double effect. In The Oxford handbook of bioethics, ed. Bonnie Steinbock, 114–149. Oxford: Oxford University Press.Google Scholar
  20. 20.
    Aquinas, Thomas. 1980. Summa theologiae. In Opera omnia, vol. 2, ed. Roberto Busa and S.J. Stuttgart-Bad Cannstatt: Frommann-Holzboog.Google Scholar
  21. 21.
    Parikh, Mahendra N. 2006. Destructive operations in obstetrics. Journal of Obstetrics and Gynecology of India 56: 113–114.Google Scholar
  22. 22.
    Marquis, Donald B. 1991. Four versions of double effect. Journal of Medicine and Philosophy 16: 515–544.Google Scholar
  23. 23.
    Quinn, Warren. 1989. Actions, intentions, and consequences: The doctrine of double effect. Philosophy & Public Affairs 18: 334–351.Google Scholar
  24. 24.
    O’Rourke, Kevin. 2010. Complications. America 2: 15–16.Google Scholar
  25. 25.
    Keffer, J.H. 2010. The placenta is key. America 16: 28–29.Google Scholar
  26. 26.
    Jonsen, Albert R., and Stephen Toulmin. 1988. The abuse of casuistry: A history of moral reasoning. Berkeley: University of California Press.Google Scholar
  27. 27.
    Hart, H.L.A. 1968. Intention and punishment. In Punishment and responsibility: Essays in the philosophy of law, 113–135. Oxford: Oxford University Press.Google Scholar
  28. 28.
    Foot, Philippa. 1978. The problem of abortion and the doctrine of double effect. In Virtues and vices and other essays in moral philosophy, 19–32. Berkeley: University of California Press.Google Scholar
  29. 29.
    Clark, Peter A., S.J. 2000. Methotrexate and tubal pregnancies: Direct or indirect abortion? Linacre Quarterly 16: 7–24.Google Scholar
  30. 30.
    Delaney, Neil. 2007. Review of Double-effect reasoning: Doing good and avoiding evil, by T.A. Cavanaugh. Notre Dame Philosophical Reviews. October 10. Accessed April 10, 2011.
  31. 31.
    Donagan, Alan. 1991. Moral absolutism and the double-effect exception: Reflections on Joseph Boyle’s “Who is entitled to double effect?” Journal of Medicine and Philosophy 16: 495–509.Google Scholar
  32. 32.
    Austin, J.L. 1979. Three ways of spilling ink. In Philosophical papers, 3rd ed, ed. J.O. Urmson and G.J. Warnock, 273–287. Oxford: Oxford University Press.CrossRefGoogle Scholar
  33. 33.
    Anscombe, Elizabeth. n.d. Action, intention and “double effect”. Proceedings of the American Catholic Philosophical Association 56: 12–25.Google Scholar
  34. 34.
    Nagel, Thomas. 1986. The view from nowhere. Oxford: Oxford University Press.Google Scholar
  35. 35.
    Keenan, James F., S.J. 1996. The return of casuistry. Theological Studies 57: 123–138.Google Scholar
  36. 36.
    Keenan, James F., S.J. 1999. Applying the seventeenth-century casuistry of accommodation to HIV prevention. Theological Studies 60: 492–512.Google Scholar
  37. 37.
    Ford, John C., S.J. 1944. The morality of obliteration bombing. Theological Studies 5: 261–309.Google Scholar
  38. 38.
    Hare, R.M. 1993. Is medical ethics lost? Journal of Medical Ethics 19: 69–70.CrossRefGoogle Scholar
  39. 39.
    Bretzke, James T., S.J. 2007. The lesser evil. America 26: 16–18.Google Scholar
  40. 40.
    Cahill, Lisa Sowle. 1981. Teleology, utilitarianism, and Christian ethics. Theological Studies 42: 610–629.Google Scholar
  41. 41.
    Sulmasy, Daniel P. 2005. Double effect reasoning and care at the end of life: Some clarifications and distinctions. Vera Lex 6: 107–145.Google Scholar

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© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Center for Liberal EducationVillanova UniversityVillanovaUSA

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