Archbishop's web site Denver Catholic Register Parishes Catholic Pastoral Center
March 14, 2001
Franciscan doctor brings ethics to medicine
200 turn out to hear Brother Daniel Sulmasy address `the rule of double effect'
By Roxanne King
Doctor and Franciscan Brother Daniel P. Sulmasy of New York was in town March 8 to do what he does best —clarify moral principles in medical situations when there is a conflict between what people's hearts tell them they should do and what they think the Church would have them do when it comes to end-of-life care for patients.
The 45-year-old Brother-doctor holds the Sisters of Charity Chair in Ethics at St. Vincent's Hospital in New York City. He serves as director of the Bioethics Institute of New York Medical College and he is a practicing general internist.
The topic he took on at St. Joseph's Hospital was "End-of-Life Care and the Rule of Double Effect." More than 200 turned out for the talk, the latest in the Archbishop's Symposium series sponsored by the Respect Life Office.
Before his presentation, Brother Sulmasy gave an interview to the Register.
"The rule of double effect is a fairly old moral principle," Brother Sulmasy said. "A doctor will often have a conflict of obligations, one is to relieve the pain of the patient, the other is to preserve life."
For example, one of the best drugs for treating pain, morphine, has the potential side effect of decreasing a patient's ability to breathe, the Brother-doctor said.
"The physician can then be in a position of saying, `Well, should I treat the pain or do I not treat the pain because I'll be doing euthanasia by doing that?'" Brother Sulmasy said. "The rule of double effect allows the physician to proceed under the following conditions: One, that whatever the actions is, it not be intrinsically evil. Second, that even if you foresee a bad effect, that what you intend to bring about is a good effect.
"In the case of the morphine, the good effect is treating the pain. The doctor would also see the possibility of shortening the patient's life, but not intend that," he continued.
"The third condition is that whatever the bad effect is, it can't be the cause of the good effect," Brother Sulmasy said, explaining that the third condition is to keep people honest about their intentions. "In the case of the morphine, the bad effect is not the cause of the good effect. It's a true side effect."
A fourth condition of the rule of double effect requires that one have "a proportianately grave reason" to proceed, the Brother-doctor said.
"In most cases, that means that the good effects in the situation far outweigh the bad effects," Brother Sulmasy said. "In the case of morphine, the good of relieving pain when they only have a few days to live, outweighs the bad effects of possibly shortening their life, by a possibly very short amount of time."
According to the moral rule, it is "perfectly morally appropriate" to give morphine to patients who are dying, Brother Sulmasy said.
"It's not the same as euthanasia," he said.
The side effects of morphine are often exagerated, the Brother-doctor said, noting that in the book "Final Exit," by Derek Humphrey, founder of the Hemlock Society, the author discourages people from attempting to commit suicide with morphine because they are likely to fail.
"People can feel comfortable as Catholics, both taking morphine if they are a dying patient or if they are a health care professional giving morphine," Brother Sulmasy said.
Offering an example of where the rule of double effect doesn't apply, Brother Sulmasy cited arguments by Jack Kevorkian's lawyer who said that in giving carbon monoxide to patients, Kevorkian didn't intend to kill, he only intended to relieve suffering.
"This is clearly wrong," Brother Sulmasy said. "Because carbon monoxide doesn't have the ability to relieve pain, only by killing. So this violates the rule of double effect."
Kevorkian claimed to have assisted in 130 suicides, some using carbon monoxide, before he was convicted of second-degree murder three years ago in Michigan. A popular lecturer, Brother Sulmasy is a frequent contributor to medical journals. He has written a book, "The Healer's Calling," (1997 Paulist Press) on spirituality for health care professionals. He is co-editor of "Methods in Medical Ethics," which is set for release this spring (Georgetown University Press). "I consider much of my work to be `pre-evangelization,'" Brother Sulmasy said. "I speak mostly to secular medical audiences, but I think that by raising questions of ethics and values for people, that I hopefully leave them with the ultimate source of what those values are, my faith and the faith of Catholics — the Gospel of Jesus Christ. "I typically do so using the natural law tradition of the Church's teaching, which says those values should be philosophically available to all people of reason and good will, even if they don't share our faith," he continued. "Thus, in some ways, what I also hope to do is to maintain a voice for Catholic ideas in the secular marketplace." Brother Sulmasy did just that, said Mimi Eckstein, director of the Respect Life Office. "Our role in sponsoring these presentations is to bring these issues to Catholics so they can discern what's right and wrong in the arguments they hear in our society today," Eckstein said. "You can't be discerning if you don't know. He fulfilled that mission perfectly."
