Significantly, neither the pope’s remarks, nor the Declaration on Euthanasia, place any emphasis on the importance of obtaining the voluntary and informed consent of patients, where possible, before shortening their lives.
The doctrine of double effect states that two doctors may, to all outward appearances, do exactly the same thing: that is, they may give patients in identical conditions an identical dose of morphine, knowing that this dose will shorten the patient’s life.
Yet one doctor, who intends to relieve the patient’s pain, acts in accordance with good medical practice, whereas the other, who intends to shorten the patient’s life, commits murder.
Cook had little time for such subtleties.
Only “a very naive doctor” would think that giving a person a lot of morphine was not “prematurely sending them to their grave,” he told Fink, and then bluntly added: “We kill ’em.”
In Cook’s opinion, the line between something ethical and something illegal is “so fine as to be imperceivable.”
At Memorial Medical Center, physicians and nurses found themselves under great pressure. Exhausted after 72 hours with little sleep and struggling to care for their patients, they were not in the best position to make difficult ethical decisions.
The doctrine of double effect, properly understood, does not justify what the doctors did; but, by inuring them to the practice of shortening patients’ lives without obtaining consent, it seems to have paved the way for intentional killing.
Roman Catholic thinkers have been among the most vocal in invoking the “slippery slope” argument against the legalization of voluntary euthanasia and physician-assisted dying. They would do well to examine the consequences of their own doctrines.
Peter Singer is professor of bioethics at Princeton University.
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