FIan B and lIe Boclvine oJ BouIIe EJJecl

AulIov|s) BeIecca SlangI

Bevieved vovI|s)
Souvce TIe Haslings Cenlev Bepovl, VoI. 39, No. 4 |JuI. - Aug., 2009), pp. 21-25
FuIIisIed I The Hastings Center
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3. A.
Bevenson,
Bvug
FiIes SIov MaIev Fvonoled
Unappvoved
Use,
Nev YovI
Tines,
BecenIev
18, 2006.
4. Scandinavian Sinvaslalin SuvvivaI
Slud Ovoup,
Bandonized
TviaI oJ CIoIeslevoI
Loveving
in 4444 Falienls vilI
Covonav
Heavl
Bisease TIe Scandinavian Sinvaslalin SuvvivaI
Slud
|4S),
Lancel 344
|1994)1383-89.
5.
J.M.
BalIon el
aI.,
A
Conpavison
oJ
Elanevcepl
and MelIolvex
ale in Falienls vilI
EavI
BIeunaloid
AvlIvilis,
Nev
EngIand JouvnaI
oJ
Medicine 345
|2000)
1586-93.
6.
B.J.
BvuIev el
aI.,
Five-Yeav
FoIIov-Up
oJ Falienls
Beceiving
Ina
liniI Jov CIvonic
MeIoid
LeuIenia,
Nev
EngIand JouvnaI oJ
Medicine
355
|2006)2408-24I7.
7. FIavnaceulicaI BeseavcI and ManuJacluvevs oJ Anevica
|FIBMA),
FIavnaceulicaI
Induslv FvoJiIe |WasIinglon,
B.C.
FIBMA,
2009).
8. B.A. Zavin and T.
Tse, Medicine
Moving
Tovavd
Tvanspavenc
oJ CIinicaI
TviaIs,
Science
319,
no.
5968
|2008)
1340-42.
9. S.H.
EIvingIaus
el
aI.,
Besponses
oJ MedicaI ScIooIs lo Inslilu
lionaI ConJIicls oJ
Inlevesl, JouvnaI
oJ
lIe Anevican MedicaI Associalion
299
|2008)
665-71.
10. CB.
BeAngeIis
el
aI.,
CIinicaI TviaI
Begislvalion
A Slalenenl
Jvon lIe InlevnalionaI Connillee oJ MedicaI
JouvnaI Edilovs,
JouvnaI
oJ
lIe Anevican MedicaIAssocialion 292
|2004) 1363-64.
11.
J.E.
MacIie el
aI.,
Lessons on ElIicaI Becision
MaIing
Jvon lIe
Bioscience
Induslv,
FLoS Medicine 3,
no.
5
|2006)
605-610.
12.
BocIe,
ElIicaI
Slandavds,
al
Illp//vvv.vocIe.con/covpo
vale_vesponsiIiIil/csv_veseavcI_and_deveIopnenl/elIicaI_slandavds.
Iln, accessed
ApviI
29, 2009.
13.
MevcI,
Conducling
OuvseIves
ElIicaII
and
TvanspavenlI,
al
Illp//vvv.nevcI.con/covpovale-vesponsiIiIil/Iusiness-elIics-lvans
pavenc/pviovilies-lavgels-sideIav.IlnI,
accessed
ApviI
29, 2009: AIIoll,
ElIics and
ConpIiance,
al
Illp//vvv.aIIoll.con/gIoIaI/uvI/con
lenl/en_US/40.60.1010/genevaI_conlenl_00258.Iln,
accessed
ApviI
29, 2009.
14.
IIid.: OIaxoSnilIKIine,
Covpovale
ElIics and
ConpIiance
Fvo
gvanne,
Illp//vvv.gsI.con/aIoul/covp-gov-elIics.Iln,
accessed
ApviI
29, 2009: EIi
LiII
and
Conpan,
Code oJ
Conducl,
al
Illp//vvv.IiII.con/aIoul/conpIiance/conducl/,
accessed
ApviI
29,
2009.
15.
FIBMA, FIavnaceulicaI
Induslv FvoJiIe.
16. F.B. MiIIev and C.
Weijev, Fiduciav OIIigalion
in CIinicaI Be
seavcI,
JouvnaI oJ
Lav, Medicine and ElIics
34,
no. 2
|2006)
424-440.
17. E.B.
FeIIegvino,
BeneJicence,
ScienliJic
Aulonon,
and SeIJ-in
levesl
ElIicaI BiIennas in CIinicaI
BeseavcI,
CanIvidge QuavlevI oJ
HeaIlIcave ElIics 1
|1992)
361-69.
18. B.B. BucIanan and EO.
MiIIev,
A FuIIic HeaIlI
Fevspeclive
on
BeseavcI
ElIics,
JouvnaI
oJ
MedicaI ElIics 32
|2006)
729-33.
19.
FeIIegvino,
BeneJicence,
ScienliJic
Aulonon,
and SeIJ-inlevesl.
20. U.S.
Bepavlnenl
oJ HeaIlI and Hunan
Sevvices,
FvequenlI
AsIed
Queslions
Jov lIe
Bequivenenl
Jov Educalion on lIe Fvoleclion
oJ Hunan
SuIjecls,
al
Illp//gvanls.niI.gov/poIic/Is_educ_Jaq.Iln,
accessed
ApviI
29, 2009.
21. Anevican Boavd oJ MedicaI
SpeciaIlies,
Ouv
Hislov,
al
Illp//vvv.aIns.ovg/AIoul_ABMS/vIo_ve_ave.aspx,
accessed
Ma
5, 2009.
22. H.S.
Janes,
BeinJovcing
ElIicaI Becision
MaIing TIvougI
Ov
ganizalionaI
Slvucluve,
JouvnaI
oJ
Business ElIics 28
|2000) 43-58.
23. E.H.
ScIein,
OvganizalionaI
CuIluve and
LeadevsIip
|San
Fvancis
co, CaIiJ
Josse-Bass, 2004).
FIan B
and lIe
Boclvine oJ BouIIe
EJJecl
BY BEBECCA STANOL
Sone
opponenls
oJ aIovlion cIain lIal
enevgenc
con
lvaceplion,
IaIeIs
nolvilIslanding,
is nol
neveI
conlva
ceplive
Iul aIso aIovliJacienl in eJJecl. Based
on
lIis,
lIe
concIude lvo
lIings. TIe
concIude, Jivsl,
lIal
laIing
enevgenc conlvaceplion
is
novaII equivaIenl
lo inlenlionaI
I pvocuving
an
aIovlion,
and lIus
inpevnissiIIe.1
And sec
ond,
lIe
cIain lIal IeaIlI cave
pvovidevs
vIo
sinceveI
oI
jecl
lo aIovlion Iave a
vigIl
lo
veJuse lo
pavlicipale
in lIe
pvo
vision oJ sucI
conlvaceplion.2
Suppovlevs
oJ
enevgenc
conlvaceplion queslion
IolI
cIains.
Againsl
lIe
Jivsl,
sone
avgue
lIal lIe nedicalions in
queslion
cannol
possiII
Iave an
aIovliJacienl eJJecl Iecause
lIe
do nol
slop
a
pvegnanc.3 Againsl
lIe
second,
sone oI
jecl
lIal,
vIiIe sucI conscience cIauses ave an
undevsland
aIIe
allenpl
lo
vespecl
lIe
vigIls
oJ nedicaI
pvovidevs, lIe
vouId do so al lIe cosl oJ
palienls' vigIls
lo
oIlain
necessav
nedicaI lvealnenl.4
In vIal
JoIIovs,
I vaise a
diJJevenl issue.
Suppose
lIal
enevgenc conlvaceplion
vovIs
exaclI
as
ils
opponenls
cIain. WouId il JoIIov lIal
laIing enevgenc
conlvaceplion
is
novaII equivaIenl
lo
inlenlionaII pvocuving
an
aIovlion?
FevIaps suvpvisingI,
I sIaII
avgue
lIal il vouId nol. IJ one ac
cepls
lIe doclvine oJ douIIe
eJJecl,
lIeve vouId Ie civcun
slances in vIicI lIe Jovnev is
pevnissiIIe
even
iJ lIe Iallev is
nevev
pevnissiIIe.
BeIecca
SlangI,
FIan B and lIe Boclvine oJ BouIIe
EJJecl,
Haslings
Cenlev Be
povl39,
no. 4
|2009)
21-25.
JuI-Augusl
2009
HASTINOS CENTEB BEFOBT 21
Enevgenc Conlvaceplion Conlvaceplive
ov
AIovliJacienl?
Fivsl,
a vovd oJ cIaviJicalion. TIe levn
enevgenc
conlva
ceplion
can veJev IolI lo vavious IovnonaI nedicalions
and lo lIe insevlion oJ an IUB aJlev sex. In vIal
JoIIovs,
I
viII use lIe
pIvase enevgenc conlvaceplion
lo veJev
onI
lo
lIe vavious Jovns oJ IovnonaI
enevgenc conlvaceplion.
FIan
B,
lIe nosl connon
enevgenc conlvaceplion
soId in lIe
Uniled
Slales,
is a
pvogeslin-onI
Jovn oJ
enevgenc
conlva
ceplion.
Cevlain Jovns oJ IovnonaI IivlI conlvoI lIal conlain
IolI
eslvogen
and
pvogeslin
can aIso Ie used
as
enevgenc
conlvaceplion
vIen laIen in
Iavgev
lIan usuaI doses. Enev
genc conlvaceplion,
as I viII
use lIe levn, veJevs lo IolI.
TIe
exacl necIanisn
I
vIicI IovnonaI Jovns oJ enev
genc conlvaceplion
vovI is nol veII undevslood. TIe
pvina
v
necIanisn
seens lo Ie
inIiIiling
ovuIalion. Bul
JaiIing
lIis,
lIe na
aIso
pvevenl
JevliIizalion ov
inpaiv
lIe
inpIan
lalion oJ a JevliIized
egg
in lIe ulevus. SucI nedicalion
na
Ie loxic lo
spevn,
vIicI vouId inlevJeve vilI JevliIizalion.
And il aIso causes ninov
cIanges
in lIe endonelviun.
WIelIev lIe
cIanges
ave suJJicienl lo
pvevenl inpIanlalion
is
nol
Inovn:
sevevaI sludies
suggesl lIe
ave nol. Bul deJinilive
pvooJ
eilIev
va
is unavaiIaIIe al
pvesenl.5
TIis Iasl
|possiIIe)
necIanisn is lIe souvce oJ lIe conlvo
vevs. Opponenls avgue
lIal iJ lIeve ave cases in vIicI
|1)
lIe
Jivsl lvo necIanisns
JaiI, |2)
JevliIizalion occuvs, and
|3)
lIe
cIanges
in lIe endonelviun
pvevenl
lIe JevliIized
egg
in
queslion
Jvon
inpIanling,
lIese cases conslilule aIovlions. OJ
couvse, iJ lIe nedicalion Junclions as
Ioped,
lIen lIeve viII
Ie
no JevliIized
egg
and
no aIovlion. And
ve
na
nevev
Inov,
in
an
pavlicuIav
case, vIal
exaclI
Ias occuvved. Bul on lIeiv
viev,
lIal does nol aIsoIve us oJ
vesponsiIiIil
Jov lIe cases in
vIicI
an aIovlion does occuv, and lIe Jacl venains lIal
enev
genc conlvaceplion
sIouId Ie counled
as an
aIovliJacienl.
Suppovlevs
oJ
enevgenc conlvaceplion
Iave
vesponded
in
al Ieasl lvo
vas.
Sone Iave
avgued
lIal,
even iJ
enevgenc
conlvaceplion
Junclions
exaclI
as ils
opponenls
Jeav,
il couId
nol
possiII
cause an aIovlion. TIe
Iongslanding
consensus
in lIe nedicaI
connunil
is lIal
pvegnanc Iegins
vIen a
JevliIized
egg inpIanls
ilseIJ in lIe ulevus.6 And
evevone
agvees
lIal
enevgenc conlvaceplion
cannol cause lIe levni
nalion oJ a JevliIized
egg
lIal Ias
aIvead inpIanled
ilseIJ in
lIe ulevus.
Supposing
lIal aIovlion is lIe deIiIevale levnina
lion oJ
pvegnanc, lIe
concIude lIal
enevgenc conlvacep
lion cannol
possiII
cause an aIovlion.7
TIis is nol a
vev pvonising
Iine oJ
lIougIl.
IJ soneone
opposes
aIovlion
on lIe
gvounds
lIal
a Jelus is a
pevson
Jvon
lIe nonenl oJ
conceplion,
vIal Ie
oIjecls
lo is lIe deslvuc
lion oJ lIal JelaI IiJe. TIe
ending
oJ a
pvegnanc, pev
se, is nol
lIe
oIjecl
oJ novaI concevn. Fov lIose vIo IeIieve lIal
pev
sonIood
Iegins
al
conceplion,
lIe
Ie queslion
is vIelIev
enevgenc conlvaceplion Ivings
aIoul lIe deslvuclion oJ an
aIvead
conceived
enIvo.
TIe
opponenls
oJ
enevgenc
con
lvaceplion
IeIieve
lIal,
in sone
cases, il does.8
TIe
lIeveJove
concIude lIal il IiIIs a Iunan
pevson,
vIo Ias
a
vigIl
lo IiJe.
TIal is lIe
oIjeclion.
Fvon lIis
pevspeclive,
vIelIev ve caII
enevgenc conlvaceplion
aIovliJacienl ov
conlvaceplive
is
nove a senanlic
queslion
lIan a novaI one.
Suppovlevs
oJ
enevgenc conlvaceplion
do Iave a nove
pvonising
Iine oJ
avgunenl. Leaving
aside lIe
queslion
oJ
vIelIev
an pevson
is
jusliJied
in
using enevgenc conlvacep
lion,
lIe avgue
lIal IeaIlI cave
pvovidevs
Iave no
vigIl
lo
den IegaII
sanclioned,
nedicaII necessav
IeaIlI cave lo
pa
lienls.
Ov,
al lIe
vev Ieasl,
lIe
ove
lIe
palienl
a veJevvaI lo a
pvovidev
vIo viII
dispense enevgenc conlvaceplion.
I viII
nol
expIove
lIe delaiIs oJ lIis
avgunenl
Ieve,
concevning
vIicI lIeve is
aIvead
a
signiJicanl
Iilevaluve. Bul Iel ne nole
lvo
lIings
Fivsl,
lIeve is
nolIing
in lIis
avgunenl
lIal is
pav
licuIav lo lIe deIale
ovev
enevgenc conlvaceplion.
TIe
pvop
ev IaIance Ielveen
a
IeaIlI
pvovidev's vigIl
lo acl in Iine vilI
Iis conscience and a
palienl's vigIl
lo oIlain
nedicaII
neces
sav,
IegaII
sanclioned lvealnenl
appIies
lo a nunIev oJ olIev
issues. TIe nosl oIvious oJ lIese
is,
oJ couvse, aIovlion. Sec
ond,
lIe
avgunenl
does
nolIing
lo
queslion
vIelIev enev
genc conlvaceplion veaII
is
novaII equivaIenl
lo an
eavI
aIovlion.
TIal is nol
necessaviI
a
pvoIIen
Jov deJendevs oJ enev
genc conlvaceplion, pvovided lIe
ave
viIIing
lo deJend lIe
vigIl
lo aIovlion
as veII. Bul lIeve ave al Ieasl lvo veasons
vI
il is vovlI
ansveving
anva.
Fivsl,
il is
pIiIosopIicaII
inlevesling
in ils ovn
vigIl,
as I
Iope
lo sIov in lIe nexl sec
lion oJ lIe
papev.
Second?and Jvon
a nove
pvaclicaI
sland
poinl?lIe avgunenl
Jov
enevgenc conlvaceplion
is
slvongev
iJ il does nol
depend
on a
genevaI
deJense oJ
aIovlion,
vIicI
is ilseIJ
so
conlvovevsiaI.
FIan B and lIe Boclvine oJ BouIIe EJJecl
Suppose
aII oJ lIe
enpivicaI
Jacls
ave as
opponenls
oJ
enev
genc conlvaceplion pvesune
lIen lo Ie sucI
conlvacep
lion vovIs
pvinaviI I IIocIing
ovuIalion ov
JevliIizalion,
Iul aIso aIlevs lIe
naIe-up
oJ lIe
endonelviun,
naIing
lIe
vonI
an
inIospilaIIe pIace
Jov lIe JevliIized
egg
lo
inpIanl.
Boes il lIen JoIIov lIal lIeve is no novaI diJJevence Ielveen
laIing enevgenc conlvaceplion
and
oIlaining,
Jov
exanpIe,
a
Jivsl lvineslev
suvgicaI
aIovlion?
Nol iJ one
accepls
lIe doclvine oJ douIIe eJJecl. TIeve
ave
a nunIev oJ diJJevenl
vas
oJ
JovnuIaling
lIe
doclvine,
and il
is nol
n puvpose
Ieve lo decide
anong
lIen.9 Fov
n pve
senl
puvposes,
vIal
lIe
sIave in connon is suJJicienl. TIe
doclvine naIes
a cvuciaI dislinclion Ielveen Iavn lIal a
pev
son
neveI
Jovesees viII Ie lIe vesuIl oJ Iev
aclion,
and Iavn
lIal sIe inlends eilIev
as a neans ov as an end.
Accovding
lo
lIe doclvine oJ douIIe
eJJecl,
il
na
Ie
novaII jusliJiaIIe
lo
pevJovn
an aclion lIal
one Jovesees viII vesuIl in sone Iavn
even iJ il vouId Ie
unacceplaIIe
lo ain al lIal
vev
sane
Iavn,
eilIev as an end ov as a neans. WIelIev lIis is so in
an
pavlicuIav
case
depends
on vIelIev lIe
good
lo Ie acIieved is
pvopovlionaI
lo lIe Iavn lIal is Joveseen. I viII
avgue
lIal laI
ing
IovnonaI
conlvaceplion
can Ie
jusliJied I
lIe doclvine oJ
douIIe eJJecl even iJ il is lvue IolI lIal il can Iave an aIovli
22 HASTINOS CENTEB BEFOBT JuI-Augusl
2009
Jacienl
eJJecl,
and lIal one
na
nevev
inlenlionaII
oIlain an
aIovlion.
Soneone vIo oIlains
a Jivsl lvineslev
suvgicaI
aIovlion di
veclI
inlends lo secuve lIe dealI oJ lIe
Jelus,
eilIev as an end
ov as a neans lo sone olIev end. Bul soneone vIo uses
enevgenc conlvaceplion
need nol inlend lIe dealI oJ
an
pavlicuIav
Jelus. I don'l
nean
lIis in lIe lviviaI
sense
lIal sIe
na
nol IeIieve lIal
enevgenc conlvaceplion
Ias lIe
enpiv
icaI
consequences
ve ave
supposing
il does. I nean lIal sIe
na
IeIieve lIal il acls in
exaclI
lIe
vas
ils
opponenls
cIain,
and sliII laIe il vilIoul
inlending
lIe dealI oJ
an pav
licuIav Jelus. WIal sIe
na
inlend lo
do,
and vIal enev
genc conlvaceplion
does do in
lIe vasl
najovil
oJ cases, is
pve
venl lIe
conceplion
oJ a
Jelus.
SIe
na
IeIieve
lIal,
undev
ex
ceplionaI
civcunslances,
lIe
conlvaceplion
viII JaiI lo
pve
venl lIe
conceplion
oJ a
Jelus.
And in a
pvopovlion
oJ lIese
cases, lIe
cIanges
in Iev
Iod
IvougIl
aIoul
I
lIe use oJ
enevgenc conlvaceplion na
nean lIal lIe Jelus viII nol Ie
aIIe lo
inpIanl
ilseIJ in lIe
vonI. Bul sIe need nol inlend
Jov lIal lo
Iappen.
TIis use oJ lIe dislinclion
Ielveen
inlending
and Jovesee
ing na
slviIe
peopIe
as
sopIis
licaI.
Suppose
lIe vonan
laIing
lIe
enevgenc conlvaceplion
IeIieves lIal lIeve is a cevlain
cIance,
Iovevev
snaII,
lIal
sucI
conlvaceplion na
acl as
an aIovliJacienl and laIes il
anva.
SIe lIen
inlenlionaII
pevJovns
an aclion lIal sIe IeIieves
na
cause lIe dealI oJ
lIe Jelus. Hov is lIal nol
inlending
lo cause lIe dealI oJ lIe
Jelus?
Bul lIis is a
nislaIe. Nol
evev
eJJecl oJ a
pevson's
aclion
need Ie inlended. An
exanpIe
Jvon anolIev avea oJ IioelIics
na
IeIp
Ieve.
Opponenls
oJ eulIanasia
genevaII
concede
lIal ve
na give ding palienls IigI
doses oJ
novpIine
even
iJ ve
Inov lIal sucI lvealnenl
na
Iaslen dealI. WIal ve
na
nol
do,
lIe
cIain,
is
diveclI
inlend lIe dealI oJ lIe
pa
lienl and adninislev lIe
novpIine
as a neans lo lIal end. So
lIe sane
aclion?adninisleving novpIine?Ias
a
diJJevenl
novaI slalus
depending
on lIe slvucluve oJ ouv inlenlions. Be
cause lIis one aclion Ias lvo
diJJevenl
eJJecls,
il is
possiIIe
lo
diveclI
inlend one oJ lIe eJJecls and
neveI
lo Jovesee lIe
olIev. IJ ve laIe lIe
novaII good
end
|lIe
veIieJ oJ
suJJeving)
as lIe
oIjecl
oJ
ouv
inlenlion, lIe aclion
na
Ie
pevnissiIIe.
Bul iJ ve laIe lIe
novaII
Iad end
|lIe
dealI oJ lIe
palienl)
as lIe
oIjecl
oJ ouv
inlenlion,
lIe aclion viII Ie
inpevnissi
IIe.10
Suppose
FIan B vovIs
as an
aIovliJacienl, exaclI
as
ils
opponenls
cIain.
IJ
one
accepls
lIe doclvine
oJ
douIIe
eJJecl,
lIeve
ave
civcunslances lIal sliII
pevnil
ils
use.
Bul iJ lIis dislinclion vovIs in lIe end-oJ-IiJe case, il seens
lo ne lIal il nusl aIso vovI in lIe case oJ
enevgenc
conlva
ceplion.
We Inov lIal
enevgenc conlvaceplion
is
jusl
lIal,
nosl oJ lIe
line?naneI, conlvaceplive.
In
vev
vave civ
cunslances, il
na
aIso Ie aIovliJacienl. So lIe sane aclion
na
Iave lvo diJJevenl eJJecls. WIen lIis is lIe case, il is
pos
siIIe lo
diveclI
inlend
onI
one oJ lIe eJJecls and
neveI
lo
Jovesee lIe
possiIiIil
oJ lIe olIev. We can lIen
agvee
lIal di
veclI inlending
lIe dealI oJ
an
pavlicuIav
Jelus,
eilIev as a
neans ov as an
end,
is
inpevnissiIIe,
vIiIe
aIIoving
lIal iJ
ouv inlenlion is
neveI
lIe
novaII good
end?lIe
pvevenlion
oJ a
pvegnanc?lIen
lIe aclion
na
Ie
pevnissiIIe.
|Nol
evevone
viII
agvee
vilI
n
as
sunplion
lIal lIe
pvevenlion
oJ
a
pvegnanc
can Ie a
novaII
good
end?an issue I addvess in
lIe JinaI seclion oJ lIis
essa.)
Indeed,
il seens lo ne
lIal
opponenls
oJ
enevgenc
conlva
ceplion
nusl
accepl sonelIing
IiIe lIe inlend/Jovesee dislinc
lion. TIe
IodiI cIanges
IvougIl
aIoul
I
IovnonaI
Jovns oJ
enevgenc conlvacep
lion can Ie and
ave
IvougIl
aIoul in olIev
vas.
Il
appeavs,
Jov
exanpIe,
lIal
IveaslJeeding
causes
cIanges
in lIe en
donelviun lIal ave siniIav lo
lIe
cIanges IvougIl
aIoul
I
lIe use oJ
enevgenc conlvacep
lion.11 IJ sucI
cIanges
can Iave
an
aIovliJacienl eJJecl in lIe Jov
nev
case, lIen lIeve is no veason
lo lIinI
lIe
cannol aIso Iave
an
aIovliJacienl eJJecl in lIe Iallev. Bul no one
laIes lIis lo Ie
a veason nol lo
IveaslJeed. TIe doclvine oJ douIIe eJJecl
sIovs Iov lIis can Ie consislenl vilI
opposilion
lo
pvocuved
aIovlion. A
IveaslJeeding
vonan
does nol
inlend lIe dealI
oJ
an
pavlicuIav
Jelus
I IveaslJeeding.
Even iJ lIeve is an ex
lveneI
vave visI oJ lIis
occuvving,
il viII occuv
onI
as a vIoI
I
unvanled side eJJecl oJ Iev aclion.
OJ couvse,
even iJ aII oJ lIis is covvecl, il does nol
el
JoI
Iov lIal lIe use oJ
enevgenc conlvaceplion
in
an pavlicuIav
case is
novaII jusliJiaIIe.
TIe dislinclion Ielveen
diveclI
in
lending
a
dealI and
neveI Joveseeing
il is
novaII inpovlanl.
Sone
nigIl go
so
Jav as lo
sa
lIal lIe Jovnev is nevev
jusliJi
aIIe,
vIiIe Jev vouId
den
lIal lIe Iallev is al
Ieasl sonelines
jusliJiaIIe.
Bul lIe dislinclion is nol a
gel
oul oJ
jaiI
Jvee cavd.
TIal I
neveI
Jovesee lIal soneone
na
die as a
vesuIl oJ
n
aclions, Iul do nol
diveclI
inlend
il,
is sonelines no
jus
liJicalion vIalsoevev.
Suppose
I visI lo ovcIeslvale a
pavlicu
IavI inpvessive
JivevovIs
dispIa,
Iul lIe
onI va
I can do
lIal is
I using vev
dangevous
JivevovIs. Il
na
nol Ie
n
inlenlion lo Iavn
anone.
Bul il vouId nevevlIeIess Ie
vvong
lo
pul
on
sucI a
dispIa.
IJ I can
Jovesee lIe
possiIiIil
JuI-Augusl
2009
HASTINOS CENTEB BEFOBT 23
oJ seveve
injuv
lo
olIevs,
lIe enlevlainnenl vaIue oJ lIe Jive
vovIs
dispIa
cannol
jusliJ laIing
lIe visI.12
Sone aclions lIal
JoveseeaII
cause Iavn?ov
nigIl
cause
Iavn?ave
vvong,
even iJ ve do nol inlend lo Iavn
anone
I connilling
lIen. Fov ouv aclion lo Ie
jusliJied,
lIe
good
ve inlend as an end nusl Ie
pvopovlionaI
lo lIe
possiIiIil
oJ
Iavn ve Jovesee. A
good
case can Ie nade lIal
enevgenc
conlvaceplion passes
lIis lesl. IJ a
oung givI
is
vaped, pve
venling
lIe
conceplion
oJ a cIiId Jvon lIal
vape
is a
genuine
good.
And il viII Iave
a
dvanalic eJJecl on lIe IiJe oJ lIe
oung givI.
Even in a case
vIeve
enevgenc conlvaceplion
is
laIen
I
an
aduIl vIo Ias consenled
lo lIe sexuaI
acl
pveced
ing
ils use, lIe
aIiIil
lo
pvevenl
a
pvegnanc
Ieve and
nov
na
Ie a
genuine good. CevlainI,
lIe
conceplion
and IivlI oJ
a cIiId is
aIvas
a
IiJe-cIanging
evenl oJ enovnous
pvopov
lions. WIen lIeve ave
good
veasons lo
pvevenl
il,
lIe
good
lo
Ie acIieved is nol a lviviaI
good?il
is nol
anaIogous
lo lIe
enlevlainnenl vaIue oJ
a
JivevovIs
dispIa.
One
nigIl oIjecl
lIal sucI a
good,
vIiIe
inpovlanl,
couId nevev Ie
pvopovlionaI
lo lIe JoveseeaIIe
possiIiIil
oJ
lIe Iavn oJ lIe
possiIIe
aIovliJacienl eJJecl. IJ lIe
enIvo
ve
aII
is a
pevson
vilI novaI
vigIls, pevIaps onI
lIe visI oJ lIe
nolIev's dealI vouId Ie
pvopovlionaI
lo lIe JoveseeaIIe
pos
siIiIil
oJ lIe dealI oJ lIe
enIvo.
Bul lIis doesn'l
seen
vigIl.13
Even on lIe
inlevpvelalion
oJ lIe
enpivicaI
Jacls nosl
JavovaIIe
lo
opponenls
oJ
enevgenc conlvaceplion,
lIe
cIance lIal il viII vesuIl in lIe dealI oJ an
enIvo,
in
an
pavlicuIav
case, is
vev
snaII. And
ve
do
lIings
lIal Iave a
JoveseeaIIe visI oJ
IiIIing
soneone aII lIe line. We dvive
cavs
lo lIe slove, Jov
exanpIe,
in lIe JuII
InovIedge
lIal lIeve is a
vev
snaII cIance
ve
nigIl
Ie invoIved in a JalaI
cav accidenl.
TIe
good
lo Ie acIieved Ieve is in Jacl valIev lviviaI?Iul lIe
cIance oJ lIe Iad side eJJecl is so snaII lIal ve viev lIe visI
as
acceplaIIe.
In lIe case oJ
enevgenc conlvaceplion,
lIe visI
na
Ie sonevIal
IigIev?lIougI
lIal
is,
oJ couvse,
nol
cIeav?Iul lIe
good
lo Ie acIieved is aIso
gvealev.
Tvo
OIjeclions
and
Besponses
One
nigIl oIjecl
lIal
n avgunenl
sIovs Iess lIan I
cIain. Al one
poinl,
CalIoIic
IospilaIs
IoIIied
lo Ie ex
cused Jvon
a
IiII lIal
vequived
aII
IospilaIs
lo
pvovide
enev
genc conlvaceplion
lo viclins oJ
vape.
TIe CalIoIic
IospilaIs
veve in Javov oJ
pvoviding enevgenc conlvaceplion
lo viclins
oJ
vape,
Iul
onI JoIIoving
a
negalive
lesl Jov ovuIalion. TIe
vovv
seened
lo Ie
lIal,
iJ ovuIalion Iad
aIvead
occuvved,
lIen lIe eJJecl oJ FIan B couId nol Ie
conlvaceplive.
TIis is
inpovlanl
lo
n avgunenl
Iecause I Iave Jocused
on lIe in
lenlions oJ lIe
pevson laIing
FIan B. IJ one Inovs lIal FIan
B cannol Junclion
as a
conlvaceplive,
lIen
one cannol laIe il
vilI lIe inlenlion lIal il viII. So one
nigIl
lIinI I an con
nilled lo
deJending
lIe
posilion
deJended
I
lIe CalIoIic
IospilaIs.
Bul a
posilive
ovuIalion
lesl vouId nol sIov lIal il is in
possiIIe
Jov FIan B lo Junclion
as a
conlvaceplive.
We Inov il
can inIiIil ovuIalion.
FaiIing
lIis,
il
nigIl
eilIev inlevJeve
vilI JevliIizalion
ov
inpaiv inpIanlalion.
Because
inlevJeving
vilI JevliIizalion is aIso a
conlvaceplive
eJJecl,
one couId sliII
laIe il vilI lIe
conlvaceplive
eJJecl as one's
goaI,
even iJ one
Ias a
posilive
lesl Jov ovuIalion.14
And in
an
evenl, lIis
vovv
is nol
enougI
lo
give pIav
nacisls a
vigIl
lo veJuse lo JiII
pvescviplions
Jov FIan B. TIe
pIavnacisl
does nol Inov vIelIev lIe
palienl
Ias lvied lo
oIlain
an
ovuIalion lesl
ov, iJ sIe
Ias,
vIal lIe vesuIl is. So
even iJ il veve
vvong
lo use
enevgenc conlvaceplion
vilIoul
a
negalive
ovuIalion lesl, lIe
pIavnacisl
cannol Inov lIal il
viII Ie used in lIis
va.
And lIe neve Jacl lIal a nedicalion
na
Ie used in a
novaII iIIegilinale
nannev is nol
genevaII
a
good
veason Jov a
pIavnacisl
lo veJuse lo dislviIule il. IJ il
veve,
pIavnacisls
sIouId Ie
veJusing
lo JiII
pvescviplions
Jov
aII Iinds oJ
nedicalion?cevlainI,
Jov
exanpIe,
Jov nov
pIine, oxcodone,
and olIev
slvong
navcolics.
Il is lvue, Iovevev,
lIal
n avgunenl
is Iiniled in a diJJev
enl
va.
An
appeaI
lo lIe doclvine oJ douIIe eJJecl
supposes
lIal lIe end ained al is
novaII good.
I cIain lIal vonen
vIo use
enevgenc conlvaceplion
need
onI
inlend lIe con
lvaceplive
eJJecl oJ lIe
nedicalion,
and nol
an possiIIe
aIov
liJacienl eJJecl il
na
Iave. IJ one denies lIal even lIe Jovnev
is a
pevnissiIIe
end,
lIen lIe doclvine oJ douIIe eJJecl naIes
no
diJJevence.
TIis is aII lvue. Bul iJ
opponenls
oJ
enevgenc conlvacep
lion
oIjecl
lo ils use on lIese
gvounds,
il needs lo Ie nade
cIeav lIal
lIe oIjecl
lo lIe use oJ aII Jovns oJ IivlI conlvoI?
incIuding,
Jov
exanpIe,
Iavviev nelIods oJ
conlvaceplion.
Bul
opponenls
oJ
enevgenc conlvaceplion
seened lo Iave
a
spe
ciaI
oIjeclion
lo
enevgenc conlvaceplion.
|We
aven'l
Ieaving
a
cIovus oJ denands Jov conscience cIauses
aIIoving pIav
nacies nol lo seII
condons,
Jov
exanpIe.)
So il is Iavd lo see
Iov lIis
poinl
viII
IeIp
lIen.
We ave
IeJl, lIen,
vilI a
conpIicaled veIalionsIip
Ielveen
enevgenc conlvaceplion
and aIovlion. Even iJ IovnonaI
conlvaceplion
Junclions sonelines
as an
aIovliJacienl,
ils use
is nol
novaII
idenlicaI lo
pvocuving
an
eavI
aIovlion.
AcInovIedgnenls
I vouId IiIe lo lIanI
JoIn
Avvas,
TaIIol
Bvevev,
and EIizaIelI
Fenlon Jov
IeIpJuI
connenls on an eavIiev dvaJl oJ lIis
essa.
1. See
J.
WiIIs,
TIe FiII Hov Il WovIs and FaiIs,
FIavnacisls
Jov
LiJe
InlevnalionaI,
Illp//vvv.pJIi.ovg/Jaq_oc.IlnI,
accessed
Augusl
28,
2008:
B. Feav, AIovlion
FvoposaI
Sels Condilion
on
Aid,
Nev YovI
Tines,
JuI
15, 2008:
S. Sinon,
BuIes Lel HeaIlI WovIevs
Ben
AIov
lion,
WaII Slveel
JouvnaI, Augusl
22,
2008.
2. Undev lIe BusI adninislvalion,
lIe
Bepavlnenl
oJ HeaIlI and
Hunan Sevvices
appeavs
lo
suppovl
lIe second cIain.
TIe
Iave
pvo
posed
lIal aII
vecipienls
oJ aid Jvon JedevaI IeaIlI
pvogvans
Ie
vequived
lo
vecognize
a
vigIl
oJ veJusaI lo
pavlicipale
in aIovlion sevvices. And lIe
oviginaI pvoposaI
deJined aIovlion in lIis
va an
oJ lIe vavious
pvo
ceduves?incIuding
lIe
pvescviplion, dispensing
and adninislvalion oJ
an
dvug
ov lIe
pevJovnance
oJ
an
pvoceduve
ov
an
olIev aclion?lIal
vesuIls in lIe levninalion oJ lIe IiJe oJ a Iunan
Ieing
in ulevo Ielveen
conceplion
and naluvaI IivlI,
vIelIev IeJove ov aJlev
inpIanlalion.
BolI
opponenls
and
suppovlevs
oJ lIe IiII
agvee
lIal lIe Iasl cIause in
lIe vuIe vas inlended lo
Iving enevgenc conlvaceplion
undev ils
24 HASTINOS CENTEB BEFOBT JuI-Augusl
2009
puvviev.
TIe cIause in
queslion
vas
dvopped
Jvon
suIsequenl
dvaJls oJ
lIe
poIic,
Iul
opponenls vovv
lIe
poIic
venains
essenliaII
un
cIanged.
See B.
Slein,
Fvoleclions Sel Jov AnliaIovlion HeaIlI WovI
evs,
WasIinglon
Fosl,
Augusl
22,
2008.
3. See FIanned
FavenlIood,
Enevgenc Conlvaceplion |Movning
AJlev
FiII),
Illp//vvv.pIannedpavenlIood.ovg/IeaIlI-lopics/enev
genc-conlvaceplion-novning-aJlev-piII-4363.Iln,
accessed
Augusl
26,
2008.
4. A
vigIl
oJ veJusaI lo
pavlicipale
in
pvoviding enevgenc
conlva
ceplion
is
open
lo veaIev and
slvongev inlevpvelalions.
On a
veIaliveI
veaI
inlevpvelalion,
il
nigIl inpI onI
a
vigIl
oJ veJusaI lo JiII a
pve
scviplion
Jov
enevgenc conlvaceplion.
On a
slvongev inlevpvelalion,
il
nigIl
aIso
inpI
a
vigIl
oJ veJusaI lo veJev lIe
palienl
lo a
pIavnacisl
vIo viII JiII lIe
pvescviplion.
Mosl cvilics seen
especiaII
concevned lo
avgue againsl
lIe
slvongev
vevsion. See A.
AscI,
Tvo CIeevs Jov Con
science
Exceplions, Haslings
Cenlev
Bepovl
36,
no. 6
|2006) 11-12:
B.
Bvessev, FvoJessionaIs,
ConJovnil,
and
Conscience,
Haslings
Cenlev
Bepovl
35,
no. 6
|2005) 9-10:
L.
LonasI
and E.
Fenlon,
Bispensing
vilI
LiIevl
Conscienlious BeJusaI and lIe
Movning
AJlev
FiII,
Jouv
naI
oJ
Medicine and
FIiIosopI
30,
no. 6
|2008)
579-92. See aIso
J.
BIuslein,
Boing
WIal lIe Falienl Ovdevs
Mainlaining Inlegvil
in lIe
Boclov-Falienl
BeIalionsIip,
BioelIics 7
|1993) 289-314:
and N.
ZoIav,
Coopevalion Bespile Bisagveenenl
Fvon FoIilics lo HeaIlI
cave,
BioelIics 17
|2003)
121-41.
5. A.
OIasiev,
Enevgenc
FoslcoilaI
Conlvaceplion
Beviev
AvlicIe,
Nev
EngIand JouvnaI oJ
Medicine 337
|1997)
1058-64.
6. B.B.
OoId,
TIe
InpIicalions
oJ
BeJining
WIen a Wonan Is
Fvegnanl,
TIe OullnacIev
Bepovl
on FuIIic
FoIic
8,
no. 2
|2005)
7-10.
7. See FIanned
FavenlIood,
Enevgenc Conlvaceplion |Movning
AJlev
FiII),
as veII as FIanned
FavenlIood,
AsI Bv. CuIIins
Enevgenc
Conlvaceplion, Illp//vvv.pIannedpavenlIood.ovg/IeaIlI-lopics/asI
dv-cuIIins/asI-dv-cuIIins-enevgenc-conlvaceplion-5363.Iln,
accessed
on
Augusl
28, 2008.
8.
Ov,
al
Ieasl,
lIe
IeIieve lIal il
vev IiIeI Ivings
aIoul lIe de
slvuclion oJ an
aIvead-conceived enIvo.
9. See W.
Quinn,
Aclions, Inlenlions,
and
Consequences
TIe Boc
lvine oJ BouIIe
EJJecl,
in
MovaIil
and Aclion
|CanIvidge,
U.K. Can
Ividge Univevsil
Fvess, 1993), 175-93:
F.
Fool,
AIovlion and lIe Boc
lvine oJ BouIIe
EJJecl,
in Vivlues and Vices
|OxJovd,
U.K. OxJovd Uni
vevsil
Fvess, 2002), 19-32:
O.E.M.
AnsconIe, Aclion, Inlenlion, and
'BouIIe EJJecl,'
in Hunan
LiJe,
Aclion,
and ElIics
|Exelev,
U.K. In
pvinl
Acadenic, 2005),
207-226. TIeve is vide
agveenenl
lIal lIe doc
lvine
oviginales
in
Aquinas, aIlIougI
AnsconIe dissenls. See
Aquinas,
Sunna
TIeoIogiae,
II-II,
Q.
64,
avl. 7.
10. See L.B.
Kass,
Is TIeve a
BigIl
lo Bie?
Haslings
Cenlev
Bepovl
23,
no. 1
|1993) 34-43:
E.B.
FeIIegvino,
Boclovs Musl Nol
KiII,
JouvnaI oJ
CIinicaI ElIics 3
|1992) 95-102: and CounciI on ElIicaI and
JudiciaI
AJJaivs,
Anevican MedicaI Associalion,
Becisions Neav lIe
End oJ
LiJe, JouvnaI
oJ
lIe Anevican MedicaI Associalion 276
|1992)
2229-33.
U.S. Biaz el
aI.,
BeIalive ConlviIulions oJ AnovuIalion and LuleaI
FIase BeJecl lo lIe Beduced
Fvegnanc
Bale oJ
Bveasl-Feeding
Wonen,
FevliIil
and
SleviIil
58,
no.
3
|1992)
498-503.
12. See
Fool,
AIovlion and lIe Boclvine oJ BouIIe
EJJecl, 22, and
aIso W.
FilzFalvicI,
SuvpIus EnIvos, Nonvepvoduclive CIoning,
and
lIe Inlend/Fovesee
Bislinclion,
Haslings
Cenlev
Bepovl
33,
no.
3
|2003)
29-36.
13. Il aIso
appeavs
lo Ie
inconpaliIIe
vilI lIe
poinl
I naIe aIove?
lIal no one
oIjecls
lo
IveaslJeeding,
even
lIougI
il
appeavs
lo
pose
a
siniIav visI. TIe IeneJils oJ
IveaslJeeding
Jov inJanls
|and nolIevs)
ave
veII
Inovn,
Iul nol
IveaslJeeding
an inJanl is
IavdI IiJe-lIvealening.
14. Nole lIal lIe CalIoIic
IospilaIs
lIenseIves
evenluaII dvopped
lIeiv
oIjeclion, pavlI
Iecause oJ lIe
inpossiIiIil
oJ
Inoving
Iov
enevgenc conlvaceplion
vouId Junclion in lIese cases. See C.
Kealing,
CalIoIic
BisIops
in CT WiII
ConpI
vilI
Enevgenc Conlvaceplion
Jov
Bape
Viclins
Lav,
HavlJovd
Couvanl,
SeplenIev
7, 2007.
jj/l
WIal Iind
oJ
nedicaI cave vouId
ou
vanl al lIe end
oJ ouv IiJe?
7 Announcing
lIe Jivsl annuaI
Haslings
Cenlev CunniJJ-Bixon
.T.HE..
FIsician
Avavds
HASTINOS
cenlev
#
F?uv avav|3s
lolaIing
$95,000
To Ie
given
lo
pIsicians
in
vecognilion
oJ cIinicaI
# # conlviIulions and connilnenl lo end-oJ-IiJe nedicaI cave
CUNNIFF
B T 7 O N
Noninalion Jovns ave avaiIaIIe al
Jound al ion vvv.lIeIaslingscenlev. ovg
and viII Ie
accepled lIvougI SeplenIev 26,
2009.
JuI-Augusl
2009
HASTINOS CENTEB BEFOBT
25