Bishop Olmsted, St. Joseph's Hospital, St. Thomas Aquinas & The Doctrine of Double-effect

This is a continuation of an earlier post in which I discussed Bishop Olmsted, his threat to take away the Catholic hospital's Catholic status if they fail to meet certain criteria which includes being in compliance with Church teaching, and the complicated issues surrounding the health of the mother. USA Today notes that St. Joseph’s Hospital has stated this in defense of authorizing and performing the abortion: 

“St. Joseph's has since argued that the case was more akin to removing a pregnant woman's cancerous uterus, which is permissible under church doctrine, than to a standard abortion.”

As a justification for the hospital authorizing and performing the abortion the hospital is trying to apply the principle of double effect to this case. But, doctrine of double-effect does not apply in this case. In simple as simple terms as possible I am going to explain the principle of double-effect.


First, I would ask you to think about whether this abortion killed the unborn baby directly or indirectly? Was the unborn child dying a consequence of a procedure or medicine?


Thomas Aquinas is one of those philosophers who pretty much covered all the topics. Did you know that the Church got the doctrine of double effect originates with Thomas Aquinas? Yes, indeed the principle of double effect traces all the way back to Aquinas. Aquinas’ treatment of homicidal self-defense is the basis for the Doctrine of double-effect. He uses this principle to defend soldiers at war who kill their enemy. Here is the passage ( IIa-IIae Q. 64, art. 7 ) from the Summa Theologica:

“It is written (Exodus 22:2): "If a thief be found breaking into a house or undermining it, and be wounded so as to die; he that slew him shall not be guilty of blood." Now it is much more lawful to defend one's life than one's house. Therefore neither is a man guilty of murder if he kill another in defense of his own life.

“Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention. Now moral acts take their species according to what is intended, and not according to what is beside the intention, since this is accidental as explained above (43, 3; I-II, 12, 1). Accordingly the act of self-defense may have two effects, one is the saving of one's life, the other is the slaying of the aggressor. Therefore this act, since one's intention is to save one's own life, is not unlawful, seeing that it is natural to everything to keep itself in "being," as far as possible. And yet, though proceeding from a good intention, an act may be rendered unlawful, if it be out of proportion to the end. Wherefore if a man, in self-defense, uses more than necessary violence, it will be unlawful: whereas if he repel force with moderation his defense will be lawful, because according to the jurists [Cap. Significasti, De Homicid. volunt. vel casual.], "it is lawful to repel force by force, provided one does not exceed the limits of a blameless defense." Nor is it necessary for salvation that a man omit the act of moderate self-defense in order to avoid killing the other man, since one is bound to take more care of one's own life than of another's. But as it is unlawful to take a man's life, except for the public authority acting for the common good, as stated above (Article 3), it is not lawful for a man to intend killing a man in self-defense, except for such as have public authority, who while intending to kill a man in self-defense, refer this to the public good, as in the case of a soldier fighting against the foe, and in the minister of the judge struggling with robbers, although even these sin if they be moved by private animosity. “

There is a distinction between intent and foresight. This can apply in cases found in military ethics, medical ethics, and social ethics. If the hospital staff had removed a tumor and the unborn baby had unfortunately been affected and died that would fall under the Doctrine of Double-effect since the intention was to remove the cancerous tumor and not to kill the unborn child. A person can have foresight of what the outcome will be as a result of removing the tumor but the intention is NOT to kill the baby but rather is to save the mother’s life by removing the tumor. But, the hospital staff directly killed the unborn child in order to save the mother’s life. This does not fall under the Doctrine of double-effect.


Here are the four conditions which must be satisfied before an act is morally permissible:


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

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

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.

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

Derived from these general principles are the specific criteria for double effect. You will notice there is a great deal of overlap between the above and what follows:


1. The nature of the act is itself good, or at least morally neutral;

2. The agent intends the good effect and not the bad either as a means to the good or as an end itself;

3. The good effect outweighs the bad effect in circumstances sufficiently grave to justify causing the bad effect and the agent exercises due diligence to minimize the harm. [Wikipedia]


You can see that abortion, the direct killing of the unborn child, does not, even in the hard case of the mother with pulmonary hypertension, does not meet these criteria and cannot be considered justified according to the principle of double effect. Bishop Olmsted is correct in both his assessment and to ensure that a Catholic hospital adheres to the teachings of the Church.