Love and Double Effect
Alexander R. Pruss
September 25, 2003
Case 1 (transplant). You are a surgeon doing an appendectomy on Fred, who is otherwise healthy. You know from his file that, just by chance, his heart, lungs, bone marrow, liver and two kidneys are a perfect match for fifteen patients in your hospital who need various organs or bone marrow, of both of which there is a severe shortage of these organs; Fred, however, has refused to donate anything. If the fifteen patients do not receive the transplants today, they will die. You skillfully use your scalpel to kill Fred in such a way that no one can tell it was no accident, and you use his organs to save fifteen patients. One dead, fifteen innocent people saved.
Case 2 (bomb). A terrorist has locked fifteen hostages in a building and escaped. He has a bomb that will go off in the next half minute—there is no time to rescue the hostages. However, you know that the terrorist’s bomb’s timer requires AC power and is plugged into an outlet. The one and only way you can stop the bomb is by turning off the power to the city block. Unfortunately, you know that Fred is living on the street and is on life support which also requires AC power—his battery backup, you find out, has just failed. As a police chief, you turn off the power, and save the fifteen hostages, but Fred of course dies. One dead, fifteen innocent people saved.
I think we all sense that there is a major moral difference between these two cases. We have an inclination to say that the police chief has done the right thing if there was no way to save Fred’s life, but the surgeon has committed murder. From a consequentialist standpoint, however, there is no difference between the two cases. In both, your action is the cause of Fred’s death and you have saved fifteen innocent people. We may not feel very strongly tempted in the transplant case to go with the consequentialist intuition, because we have a very strong aversion to surgeons killing their patients, perhaps because we can all too easily imagine ourselves as on the wrong end of this transaction. But there are other cases where we might feel a stronger pull towards the consequentialist solution—the solution which simply tries to save a greater number of lives. One thinks here about people’s feelings about such things as stem cell research or direct abortion to save the mother’s life where it is harder to imagine oneself as the victim. However, I think even in the transplant case most of us have at least a weak pull in the direction of approving of the surgeon’s deed.
The consequentialist pull, I take it, is pernicious: the very fact that it approves of surgeons setting out to kill innocent people shows this much. But how can we individually and as a society at large resist the pull, especially in cases where our emotional response is less reliable? The question is both an emotional and an intellectual one. Intellectually, we want to know what is the difference between the transplant and bomb cases. Given that it really is not all that intuitively difficult to see that the surgeon does wrong but the police chief acts rightly, we want an answer that is perspicuous, an answer that while intellectually satisfying to the philosopher nonetheless does not depend on too many non-obvious facts. Moreover, we want the answer to be one that has emotional oomph: we want an answer that can motivate us to act rightly, not just in a ho-hum dutiful manner of “I know that the correct basic principles of ethics entail that it’s wrong, and hence it is wrong” but in an internalized way that inspires us and our fellows to action against the injustices that consequentialist reasoning leads to.
I think it is clear what the general outline of any answer will look like. Clearly the main difference between the transplant and bomb cases is that in the transplant case, the lethal harm done to Fred is deliberately inflicted and is a means to the achievement of one’s good purposes, while the police chief does not try to kill Fred and Fred’s death in no way advances her plan. The Principle of Double Effect now says that under some circumstances it is acceptable to perform an action which causes a very bad effect if that bad effect is not intended as a means or as an end and if the good effect is in the right proportion to the bad effect. Thus, the Principle might allow the police chief to turn off the power but not the surgeon to kill Fred. However, this simply delineates the problem more sharply: Why should we accept the Principle of Double Effect and the idea that it was wrong for the surgeon intentionally to inflict lethal harm on Fred?
In my discussion I will stick to my original cases and start by considering two popular answers: the Kantian and the Natural Law.
On the Kantian story that interests me, the surgeon does wrong because he uses the victim as a means to an end. The victim is treated as a thing rather than as a person with independent goals and plans. And that is always wrong. Persons are to be treated as persons, as beings that have the dignity of setting goals for themselves, rather than as mere objects. But Fred is not being used by the police chief: he is not a weapon in the police chief’s arsenal, but a bystander harmed incidentally. The Kantian account is, I think, emotionally satisfying and fits with how we think about the cases. It is emotionally satisfying in that once someone articulates for us the claim that persons should not be treated as mere means, that claim immediately appears to us to be a profound and convincing way of explaining the dignity that persons have as persons.
The Kantian story thus satisfies the emotions. But I think it should not satisfy the intellect. Consider another case.
Case 3 (lifeboat). You and Fred are on a lifeboat. Fred is a stubborn fellow who does not really care whether you and he drown or not. He is asleep right now, having taken a large dose of sleeping pills and having told you not to move him no matter what—not even if this were necessary to save your lives. Fred is not insane or anything like that: it is just that his value system is rather different from yours, and he is very stubborn. The boat is listing to starboard, and Fred is sleeping in the center of the boat. You will all drown unless you manage to right the boat. Your weight, it turns out, is insufficient to do that, and there are no heavy objects on the boat besides you and Fred. So you use Fred as a counterweight by dragging him to the port side of the boat.
I think it is perfectly clear that you have done the right thing in the lifeboat case. But you have used Fred as a counterweight, i.e., as a mere thing rather than a person. You have used Fred’s body in a way incompatible with Fred’s own plans, as a tool for the fulfillment of your own goals. On the Kantian criterion, it seems, you have done wrong. Intuitively, we are not bothered by the idea of using Fred as a counterweight. If challenged, we would say that Fred is being unreasonable in his absolute desire not to be moved no matter what, and we have no need to respect unreasonable decisions. However, once one makes this move, then the clear wrongfulness of the surgeon’s action in the transplant case evaporates, because whether it is wrong or not now depends on whether it would be reasonable or not for Fred to object to being killed for his organs. But whether it would be reasonable or not depends in large part on what moral assessment one makes of the case, and circularity threatens.
It appears, thus, that there are some circumstances in which it is acceptable to use a person or a person’s body as a means. Now, it may be that there is some way of refining the Kantian criterion to get around cases such as the lifeboat one. I think a substantial “persons are ends, not means” principle remains if one weakens the principle to say that it is wrong to use a person in respect of some “personhood-involving” feature as a mere means. Since perhaps Fred’s weight is not a “personhood-involving” feature of Fred, using him as a counterweight might be acceptable. But raping Fred would not be acceptable even for a good end, because it is arguably essential to rape from the standpoint of the rapist that it be the rape of a person (there is no point to depersonalizing that which is not yet a person). But once one modifies the principle in such a way, it is no longer that clear what to say about the transplant case or at least modifications of it (one could take out Fred’s heart, without killing Fred first, and argue that one was using not a personhood-involving feature of Fred but an animality-involving feature).
Alternately, one might offer a Natural Law account (and here I am depending on a paper that Mark Murphy gave last week at the University of Texas, though I am oversimplifying and likely distorting). The nature of our decision-making is such that we rationally stand committed behind not just our goals but also the means that we have chosen for the goals. The failure to achieve one’s plan by the chosen means is still a failure, even if the final goal is by chance achieved. We stand behind the means chosen, then, and the execution of these means is a component of our well-being, it is a good for us. One can now just make a quick deontological move: plainly, as Thomas notes, evil is to be avoided and good to be pursued. If one is trying to achieve an evil, even as a means, then one is plainly doing that which is to be avoided. Hence the surgeon acts wrongly. Moreover, the surgeon makes Fred’s death a component of his own good, saying, “May this evil be my good.”
I think that as far as it goes, everything I said so far is correct. But it does not go far enough. One might after all extend one’s consequentialist intuitions into the idea that, well, maybe it’s bad for me as a person that Fred’s death be a component of my good, but it’s good for me as a person that the fifteen patients’ lives be components of my good, and so overall this is a good state for me to be in. Secondly, one might worry: “But maybe Fred’s death is not really an intrinsic evil when it serves the human community, just as the death of a carrot is not an intrinsic evil when it serves a rabbit or a person.” And besides this, somehow abstract principles about achievement of plans are not emotionally moving, in the way that, I think, a good ethical theory is.
I am not saying there are no further alternatives on the books. This is a very short piece and I only have time for what I’ve said. Now I’d like to sketch a different story that has something in common with the Kantian and Natural Law accounts. This is an account from within Christian ethics. It is clear from the New Testament that all ethics is to be grounded somehow or other in love. The whole Law is contained in the commandments of love of neighbor and of God, and love is the fullness of the Law (Mt. 22:37-40; Rom. 13:8, 10; Gal. 5:14). God himself is love, and we are created in the image of God. There is, moreover, something deeply emotionally satisfying about the commandments of love. I think we can all appreciate the call to love other persons, and insofar as we do not appreciate it, I think we can often tell that this is due to a hardness in our hearts, a feature we would do well to be rid of. An ethical theory grounded in love thus has great emotional appeal and is intellectually as satisfying as anything as any alternative if it can be made applicable. I will sketch how such a theory can in fact be applied to the cases at hand.
Note first that the kind of love that the New Testament talks about—indifferently using the terms agapê and philia for it—is presumably not just an emotion, since, as Kant noted, emotions cannot be directly commanded. The primary examples of love are Christ’s dying that we might live and the Father’s sending Christ to die for us. It appears, then, that willing the good of the other person is an essential part of love. But we do not just need to assert this baldly. We can see it from the phenomenologically obvious way that genuine love seeks union with another. We wish to be united with the beloved as a whole person, including intellect and will. This union leads to a mutual indwelling, St. Thomas tells us in a deeply mystical passage (Summa Theologiae I-II, 28, 2). The beloved is found in the lover’s affections “inasmuch as it is in his affections … causing him either to take pleasure in it, or in its good, when present; or, in the absence of the object loved, by his longing, to tend … towards the good that he wills to the beloved” and conversely the lover finds himself in the beloved “inasmuch as he reckons what is good or evil to his friend, as being so to himself; and his friend's will as his own, so that it seems as though he felt the good or suffered the evil in the person of his friend”. If we are persons with intellect and will, and if it is essential for love to seek personal union, and indeed mutual indwelling, then love will indeed seek the good of the other.
Insofar, then, as we set our will on something that is unequivocally bad for the other person, thus far we are acting in a way directly contrary to the tendency of love. The beloved no longer dwells in our will and we no longer dwell in the beloved, unless somehow we manage to divide ourselves up, so that a part of our wills is directed towards the good of the beloved and a part is against it. But such self-division is contrary to self-love: for if love seeks union, then self-love seeks self-integration. (One remembers here Kant’s argument against suicide, since suicide involves the person divided against herself, and hence a contradictory will.) To act directly in a way contrary to love’s tendency, is to be unloving, as opposed to merely non-loving. It is thus to set oneself up as diametrically opposed to the call of love.
A different way of looking at it. Insofar as we intentionally act on another person, we have intentionally entered into a relationship with her—not just into a relation (for we are always related to all other people in various trivial and non-trivial ways, say by being taller or shorter than they are). But the kind of relationship we have entered into by our act, if that act is directed towards that which is unequivocally bad for that person, is thus far a relationship of hatred. In killing Fred, the surgeon acts directly against what love for Fred would call him to. Thus, either the surgeon hates Fred simpliciter or in a divided way he hates Fred. And hence he does wrong, for all acts opposed to love are wrong.
On the other hand, in the bomb case, the police chief’s relation to Fred is less direct. The amelioration or worsening of Fred’s condition does not enter into the police chief’s will. Insofar as she acts, she is being non-loving. Now, being non-loving in some respect is not directly opposed to love. After all, we humans not only cannot but should not love everybody in every possible respect: to love one’s wife in respect of her alleged divinity is to commit idolatry. There may be respects in which being non-loving is unacceptable, when indeed it becomes elevated into being unloving—for instance when it involves the squelching of love’s call to tend to the sick man by the side of road in favor of walking on to one’s appointment.
A parenthetical remark: Note how similar the reasoning here is to that of those who argue that contraception is wrong, because contraception acts in a way directly contrary to the biological union that erotic love tends to, and hence is unloving, whereas the abstinence of Natural Family Planning is not in and of itself unloving.
That direct killing of the innocent (only the innocent? that is a different question) is directly contrary to love, even to love considered in its most phenomenologically obvious aspect, namely the unitive aspect, is not hard to see; nor is it hard to see that a person who acts in such a way is subject to a moral criticism we should not want ourselves to be subject to—he is unloving. On the other hand, applications of double effect do not involve the same kind of betrayal of love of neighbor, the same kind of entering into a relationship of hate rather than of love. Insofar as one acts, one is not being loving towards the victim of the side-effect of one’s action. But one is not being unloving, and not loving in one respect is not directly opposed to loving in another respect, though being unloving is. This account, I think, can satisfy the intellect and the emotions. If we are to win the fight against consequentialism, we shall have to use the weapons of love. An ethic of love has deontological consequences.
 This is controversial, and there may be isolated exceptional passages such as the final pericope in John. However, by and large, it is hard to discern a difference in the use of the two terms. Note, for instance, that the Gospel of John indifferently talks about the disciple “hon [ho Iesous] êgapa” (19:26) and the disciple “hon ephilei ho Iesous” (20:2).
 See, e.g., my “Not Out of Lust”, Logos (forthcoming) and “Christian Sexual Ethics and Teleological Organicity”, The Thomist 64 (2000) 71–100.