Splitting hairs

...If a pa- This argues that the principle of double A call, if not fondly, the de- tient's condition morally warrants treat- effect is not only illogical, but is self-deployment of numerous con- ment, even if unlikely to succeed, it ceptive, allowing people, by a moral cepts and fine distinctions...

...If we • Catholics and Hollywood ical consistency is said to demand ac- do not, then it is fair to be accused of ra• And much more ceptance of euthanasia as well-and not tionalization, or at least moral blindness...

...Our thinking is shaped by moral questions, including: now made by proponents of euthanasia distinctions that have been passed on to • Race and justice, is to argue that, since the result is death us by the contexts in which we have including gay rights in both cases, the distinction is both fal- been acculturated...

...Or do I uphold it bethat will probably bring no benefit to cause preserving the distinction serves 8'I1.F'Hlh ~IIEE11 , 1IUIO1T11]' 11.11' • S'l't'AH'1- IU t1EIi the patient other than to suspend the my moral convictions against euthana?IH'IIAC1, II...

...Who would want that, and why would any doctor be obliged to prescribe an antibiotic in that circumstance...

...Many doctors had long considered it acceptable not to provide any life-saving treatment when the outlook was poor or hopeless, but not right to withdraw such treatment once initiated...

...One is the difference between ly only brings about the death of some75 years "feeding" a patient, taken to be an or- one with an underlying lethal disease, dinary duty of care, and providing nu- which is what biologically causes the of the Catholic trition to a dying patient by means of a death...

...I would go even further: Bedisease was killing them, not the symp- ware of those who so charge others...

...bring...

...had not put him on the respirator...

...Tubal pregnancy, me morally legitimate to run a foreseeTwo old distinctions have been qui- which is potentially lethal and which can able risk that it will kill the patient, but etly retired...

...Be tom of that disease manifested by an in- rightfully suspicious of their motives in ENTEWI)C:f"1'ION BY PETER S'rEINFELS ability to take food by mouth...

...if there is lingering hesitation among Commonweal 7 June 2, 2000 in the case of two other disputed dis- sary...

...Tube feeding, by contrast, is simply because I am more rational than CDIVMMONMRAL an invasive technological intervention those who do not...

...Foreseen but not intended" does not relieve one of direct culpability...

...Some conservatives argue if the respirator had not been turned at its most that the removal of a feeding tube from off-but then the patient would not such a patient is nothing less than al- have been alive at all if the physician thoughtful- lowing the patient to "starve" to death...

...The latter is the distinction between killing and allowLiberal Cortvictions, Cathnlec Traditions ordinary-language understanding of ing to die...

...Commonweal 8 June 2, 2000...

...II Ntkl...

...kill the patient-terminal palliationto as the burden of treatment on the pa- The criticism of the double effect then I would reject it, classifying it as a tient...

...Do I uphold that distinction -r...

...incidentally, it is often added, a quick Good ethics cannot do without distincAvailable wherever death by lethal injection would be more tions, but neither can it do without a books are sold merciful than protracted "natural" death willingness to examine them critically...

...Even a technologically simple between intended and unintended con- Charges of moral evasion and selftreatment, such as the use of an antibi- sequences if both lead to the same prac- deception are even more pronounced otic, can be burdensome if it prolongs the life of someone who is slowly dying of an otherwise painful and fatal condition...

...and that it is sophistry and self-decep- Even though arguments to cancel or tion not to see this...

...Their underlying the debate...

...G 7'5 Y Fao -11 "feeding...

...launching this variant of the ad hominem The other distinction under dispute is argument...

...the end of their lives were not described impute them to those on either side of 'I'lIlI l &, MNH'I'11\ ]rl l.l,l'S WAI UJI as starving to death...

...If the more traditional underderstood to apply to the complexity of tentionally, kill the fetus, is a classic in- standing of the double-effect principle the technology used to sustain a dying stance of invoking the principle...

...You may won- should be provided, but it can then be sleight-of-hand, to do things they would der if they matter much, and the suspi- withdrawn if the patient fails to improve...

...One of them near cousin to euthanasia, that is, the pain or comfort a specific treatment will argues that it is illogical to distinguish deliberate killing of a patient...

...So is the allows a dose that will almost certainly person, is now more commonly referred use of fatal doses of morphine...

...ease, such as Alzheimer's...

...True, the patient dies sooner than Intellectual Tradition feeding tube...

...Not until recently, how- voked in the case of providing drugs some critics (mainly of secular persuaever, did they appear of great importance such as morphine to relieve pain, critics sion) bring to it, attributing all-but-dein public issues, and not simply odd, out- have begun to appear...

...In a collection of engaging and the most important of all for policy pur- I am perfectly prepared to agree that provocative essays culled from poses...

...from a slow-acting disease...

...Tube feeding Which comes first, the desire to legitisuch a patient should not be confused mate euthanasia or the nullifying of a the CENTURY with feeding by mouth...

...A standard move tions...

...This is a judgment of the degree of principle takes two forms...

...I am sympacion may have crossed your mind that While the principle of double effect thetic to this criticism, even though I do they seem to invite as much obscuran- still has good standing, and is often in- not share the cynical perspective that tism as clarity...

...AI.LAIIAN - MEAN HF'rl13i,: EI.S1IT'AIN necessarily for long...

...nyone who has taken a some doctors) that there is no meaning- The other criticism goes a step further...

...In the case distinctions shows some recent shifts and able-but not intended-wrongful re- of a high dose of morphine, it seems to new imputations of self-deception...

...sults as a consequence...

...to refine any given moral distinction are EDITED BY PA1PICK JOF'OAN AND PAUL BAUMANN But to me an inability to eat by mouth conducted in ostensibly neutral and logis clinical evidence of impending death ical language, they are always informed COMMONWEAL in a patient suffering from a lethal dis- by ideological and moral commitments...

...Experientially at least, the latter felt like a killing of a patient in a way that providing no treatment did not...

...Yet in recent years it has been accepted (even "How do you feel about heroic Jneasures...

...According to these critics, whoever carries out the act SPLITTING HAIRS that brings about death is morally reMorality & self-deception sponsible for the death...

...A broad look at such moral ly acceptable act that will have foresee- intended or only foreseen...

...The distinction between withholding and withdrawing treatment is another one that is fading...

...otherwise consider wrong...

...I cannot tell...

...KIi1NUTON - KJ.IY.AISET11 .IUI{x,r'Ux natural process of dying, and then not sia...

...course in ethics may well re- ful distinction between them...

...They are nothing but tools of analysis, TOUCHSTONE But the distinction between allowing exceedingly useful if they illuminate real 13,11 m]r l%el> Site at n'sv' '.SimoPiS ''s.cem a patient to die and actively ending a and telling differences, but instantly dislife remains perfectly valid and neces- pensable if they do not...

...Since termination of treat- pose them to tough criticism, and to be the Church and women ment for a hopelessly ill terminal patient prepared to amend or reject them if that is a well-established moral practice, log- is where our examination leads us...

...tical result, for example, the death of a fetus because of tubal ligation and of a DANIEL CALLAHAN patient given a pain-relieving, but also lethal, dose of morphine...

...of-the-way cases for classroom debate, tions necessary to invoke the principle It would be more straightforward to use such as the rare case of a woman with a are multiple and complex, but the core a principle of lesser evil to judge acts that potentially lethal fallopian tube pregnan- thrust is that it is morally legitimate to have both good and bad consequences, cy, a favorite example of the principle of intend to carry out an otherwise moral- taking full responsibility for both, whether double effect...

...and controversial...

...The full condi- liberate obfuscation to its supporters...

...Prior to the inven- Because rationalization and self-detion of modern feeding tubes some thir- ception are so hard to detect in the use 2W1N I.1 KU'S--..%.41 ).x 'I.V,1'I-.1IN • F. .1...

...The notion of ordinary and be dealt with by removing the tube even not a dose so high that it will surely kill extraordinary treatment, often misun- though it will foreseeably, though not in- him...

...Once we are aware • Abortion and euthanasia lacious and self-deceptive, a kind of con- of this, we have the obligation to exam• Issues of faith, Catholicism science salve for physicians opposed to ine those inherited distinctions, to exand Protestantism, euthanasia...

...1) ION NK..1It.ty years ago, patients unable to eat at of moral distinctions, it is best not to llII,f..1 1'.VFHEl[ i1 11.1'Et, KE141...

...That is the difference between al- most of us have strong moral feelings, the magazine that has bridged the lowing a patient to die (for example, by that we have been influenced by the ethgap between Catholic tradition turning off a respirator)-once but no ical traditions or culture in which we and American modernity, this longer called "negative euthanasia"- were raised, and that we seek moral reaanthology explores some of the century's most important ethical and the killing of a patient (for example, sons to justify our feelings and convicby lethal injection...

...Turning off a respirator ordinariCelebrating tinctions...