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The Jonathan Dolhenty Archive |
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The Dolhenty Report A Commentary on the Human Condition by Dr. Jonathan Dolhenty OCTOBER 2000
I am sure everyone by now is familiar with the case of the conjoined twins in England. These two girls were born joined at the abdomen and, unfortunately, share some essential organs. The parents, who are devout Roman Catholics, want to leave things in the hands of God (God's will should prevail), while the physicians have assured them that both will die if not separated. On the other hand, if separation is pursued, one of the girls will surely die while the other may survive, although there is no guarantee. Obviously this is a terrible ordeal for the parents. If I had been caught in such a situation, I would be going through much soul-searching and personal grief. However, I want to leave the personal aspects of this tragedy aside and deal with the situation as an academic exercise (with all due apology to those directly involved in this situation). The situation has become a political and legal issue as well as a moral dilemma. A British court ordered that the twins be separated even though one of them will most likely die (this seems assured, since only one can actually keep the essential organs shared). The parents do not agree with the court and want things left to God's will. Leaving aside the political and legal issues involved, what are the moral and ethical considerations? I would like to examine this matter and attempt to resolve the moral conflicts by using a standard principle in moral theology and moral philosophy called "the principle of the twofold effect." It very frequently happens that an action results in more than one effect with moral implications. For instance, a government health agency may force a quarantine on to someone with a highly communicable disease. One effect of this action is to protect the public against disease and death. Another effect is to deprive a morally innocent person of his or her liberty. Now, we need to have a precise knowledge of the conditions under which we may perform an action one effect of which is morally bad. Before getting into a discussion of the principle of the twofold effect and its application, let me explain certain concepts which must be clearly understood. One, an action may be willed or intended in either one of two ways: it may be willed or intended (a) directly or (b) indirectly. (a) To will or intend directly is to will or intend a certain action either as a means to a certain end which one has in view or as the end itself (e.g., John deliberately kills Sam, his sworn enemy, and directly intends Sam's death). (b) In cases where an action is willed or intended indirectly , the person does not will or intend a certain action in itself (X), but wills or intends some other action (Y) knowing that X will result from Y. Therefore, by directly willing Y, which is the cause of X, he indirectly wills X (e.g., John sets out to sell some marijuana to children; he intends this sale only in order to make money, but he realizes that selling the marijuana may present a danger to many children; he "directly intends" (1) selling the marijuana as a means and (2) making money as the end; he "indirectly wills" the dissemination of the marijuana). Two, in discussing the twofold effect of an action we are not looking upon the action as a mere physical act. We are taking the action considered morally, that is, viewed in its conformity with or difformity from the norm of morality. An action, viewed in the abstract, may be good (helping a friend in distress), bad (murdering your brother), or indifferent (walking, eating, studying). The act of walking is in itself directed neither to a good nor to an evil end. Where, then, does the goodness or badness of such an action come from when it is actually performed? It is true that it is not directed by its very nature either to a good end or a bad end. However, it can be so directed "by the intention of the one who performs the action." For example, John is running down the street. His action of running is of its nature neither good nor bad, but may be directed toward a good end or a bad end through John's intention. If he is running to improve his health, the running itself is indifferent while the end is good. If, however, John is running to catch a child to murder him, the running is directed toward an evil end. We must also be aware of two classes of action which are evil in themselves: (1) Actions that are evil as regards the very substance of the act. Such actions under all circumstances, if knowingly and deliberately performed, are evil. The morality of such actions is absolute, for they are substantially bad. They do not depend on any particular condition for their evil. An example of an action that is substantially bad is the deliberate murder of an innocent person. No circumstance imaginable could make this action other than objectively evil. (2) Actions that are evil because of the lack of the right to perform them in the one acting. In these actions the substance of the act is indifferent, but since the one acting has not the right to perform them, they become evil. An example of such an action is the taking of another's property. The substance of this action is indifferent. It is illicit if the one taking another's property has no right to do so. Now, back to the principle of the twofold effect. This principle may be stated as follows: It is allowable to actuate a cause that will produce a good and a bad effect, provided (1) the good effect and not the evil effect is "directly intended"; (2) the action itself is good, or at least indifferent; (3) the good effect is not produced by "means" of the evil effect; and (4) there is a proportionate reason for permitting the foreseen evil effect to occur. I will now attempt to apply this principle to the case of the conjoined twins. 1. The good effect and not the evil one must be directly intended; an evil intention corrupts any action. In this case, I would submit that the good effect intended is the separation of two twins who otherwise will most likely die if not separated. I have to assume the good intentions of all involved. 2. The action itself must be good, or at least indifferent. I submit that surgery itself is not an evil action (is not intrinsically evil). The act of surgery itself is good or at least indifferent. 3. The good effect must not be produced by means of the evil effect. I submit that the evil effect (the possible death of the one twin without essential organs) is not directly intended, at least as a means of producing the good effect (life for the other twin). I admit to being less confident on this point, but I think the principle still holds. I don't think there is any evil intent on the part of the physicians or the court. 4. There must be a proportionate reason for permitting the foreseen evil effect to occur. I submit that life for the one twin who may be able to survive is a good reason for permitting the surgical separation. That, more or less, is my argument and my application of the principle of the twofold effect in this specific situation. I could be wrong. I could be misapplying the principle. I am not pretending to be Solomon here nor am I pretending to have the absolute truthful solution to this dilemma. But, I think, the physicians and the court may have moral justification on their side. Even though this may be the case, however, I would still be reluctant to criticize the parents for holding their moral position against separation of the twins. In any case, the situation is a tragedy. What would I do if I were one of the parents? I frankly don't know. I do hope I would have the understanding and sympathy of most people regardless of the moral decision I would make in this matter. I don't think that's too little to ask. The above argument is not intended to provide the only "moral" solution. I am not in any way judging the parental decision to allow "God's will" to prevail. I am saying that I am of the opinion at this time that performing the surgery would be morally permissible by applying the principle of the twofold effect. Enrich Your Life With a Philosophy Book... Enrich Your Life With a Philosophy Magazine...
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