Medical Ethics - Principle of Double Effects (PDE) Double Effect Reasoning, Doctrine of Double Effects.

The Doctrine of Double Effects consists of four conditions that must be satisfied before an act is morally permissible:

1. The nature-of-the-act condition. The action must be either morally good or indifferent.
2. The means-end condition. The bad effect must not be the means by which one achieves the good effect.
3. The right-intention condition. The intention must be the achieving of only the good effect, with the bad effect being only an unintended side effect.
4. The proportionality condition. The good effect must be at least equivalent in importance to the bad effect.

The second of these four conditions is an application of the more general principle that good ends do not justify evil means (cf. Romans 3:8).^[3]

Comments on the confirmation hearing for Dr. Tom Price:

Please stand up and be counted as being an implacable foe of Dr. Tom Price's proposals that would hollow out irreparably Medicare and the protections offered by PPACA. I have been reviewing the proposals of Dr Price and other Republicans to replace and repeal PPACA. I have been working on Health Care Reform Proposals from the time Ms. Clinton offered her proposals. Dr. Price's proposals despite the fact he has been practicing on replacing and repealing PPACA since it was enacted is the absolute worst {Rep. Ryan[Speaker] is desperate} compared to the proposals of Dr. Bob Cassidy {Sen- Louisiana] and Sen Collins, Stuart Butler Ph.D. et al- Brookings Aspen Institute, American Enterprise Institute, Sen. Orrin Hatch, Forbes- Avik Roy. It makes a mockery of the real concerns and fears of millions of our fellow Americans. I want to take this opportunity to remind Dr. Tom Price- the Cardinal Tenet of Medical Ethics is Primum Non Nocere for past 2 millennia. The other principles for a good measure that I wish to bring to his attention and yours are 1. Justice 2. Beneficence 3. Autonomy 4. Non- Maleficence as he reflects on his so-called proposals for irreparably hollowing out the safety Net for millions of our fellow Americans by imprudently and impetuously upending the protection offered by the PPACA for millions of Americans because his alleged replacement proposals would leave millions of Americans without access to care and suffering needlessly. In addition, because the preventive health interventions covered by PPACA will be unaffordable and millions of Americans may suffer increased mortality from the top 5 causes of death in America [accounts for 2/3 of all deaths in America per the CDC. After 4 years of his proposals being enacted [ I shudder to think of that happening] the percentage of preventable deaths because of thread bare health care coverage- will increase from these very high numbers- Heart Disease Deaths-30%, Cancer deaths-15%, Stroke Deaths- 28%, Chronic Lower Respiratory disease deaths- 36%, Accidental Deaths- 43%.  [Largest component Overdose deaths] He must be seriously queried about his proposals - will these actions that is likely to adversely affect the lives of millions of our fellow Americans meet these standards imposed on all Physicians - namely the Principle of Double Effects (PDE) Double Effect Reasoning, Doctrine of Double Effects.

The Doctrine of Double Effects consists of four conditions that must be satisfied before an act is morally permissible:

1.            The nature-of-the-act condition. The action must be either morally good or indifferent.

2.            The means-end condition. The bad effect must not be the means by which one achieves the good effect.

3.            The right-intention condition. The intention must be the achieving of only the good effect, with the bad effect being only an unintended side effect.

4.            The proportionality condition. The good effect must be at least equivalent in importance to the bad effect.

The second of these four conditions are an application of the more general principle that good ends do not justify evil means (cf. Romans 3:8). I have written extensively on these concerns my patients and colleagues have about the frenzy of hyperbolic rhetoric that is sadly driving the Legislative process that driving terror into the hearts of millions. In fact, the adverse effects have started already- Many millions elected not to purchase the coverage through the provisions of PPACA. This can only translate to increases tragically of preventable deaths from the 5 leading causes of death in the next 12 months, especially if replacement is not along the lines of the proposals of Sen. Collins and Sen [Dr.} Bob Cassidy. Please do everything you can to prevent Dr. Tom price from wielding his autocratic imprudent proposals to transform health care in America. e.g. Hollowing out Medicare and leaving only threadbare, vestigial remnants of the PPACA.

Velandy Manohar, MD. Distinguished Life Fellow, Am. Psychiatric Association. Steering committee- National Physician Alliance-CT, Steering Committee- Psychotherapy Caucus, Am. Psychiatric Association, Community Advisory Board- CT. State Innovation Model.