The doctrine makes a crucial distinction between harm that a person merely foresees will be the result of her action, and harm that she intends either as a means or as an end. According to the doctrine of double effect, it may be morally justifiable to perform an action that one foresees will result in some harm even if it would be unacceptable to aim at that very same harm, either as an end or as a means. Whether this is so in any particular case depends on whether the good to be achieved is proportional to the harm that is foreseen. I will argue that taking hormonal contraception can be justified by the doctrine of double effect even if it is true both that it can have an abortifacient effect, and that one may never intentionally obtain an abortion.
She attempts to "prove" her thesis as follows:Someone who obtains a first trimester surgical abortion directly intends to secure the death of the fetus, either as an end or as a means to some other end. But someone who uses emergency contraception need not intend the death of any particular fetus...She may believe that, under exceptional circumstances, the contraception will fail to prevent the conception of a fetus. And in a proportion of these cases, the changes in her body brought about by the use of emergency contraception may mean that the fetus will not be able to implant itself in the womb. But she need not intend for that to happen...Not every effect of a person’s action need be intended.
She employs an analogy:An example from another area of bioethics may help here. Opponents of euthanasia generally concede that we may give dying patients high doses of morphine even if we know that such treatment may hasten death. What we may not do, they claim, is directly intend the death of the patient and administer the morphine as a means to that end. So the same action—administering morphine—has a different moral status depending on the structure of our intentions. Because this one action has two different effects, it is possible to directly intend one of the effects and merely to foresee the other. If we take the morally good end (the relief of suffering) as the object of our intention, the action may be permissible. But if we take the morally bad end (the death of the patient) as the object of our intention, the action will be impermissible...if this distinction works in the end-of-life case, it seems to me that it must also work in the case of emergency contraception...We can then agree that directly intending the death of any particular fetus, either as a means or as an end, is impermissible, while allowing that if our intention is merely the morally good end—the prevention of a pregnancy—then the action may be permissible...Indeed, it seems to me that opponents of emergency contraception must accept something like the intend/foresee distinction.
She employs another analogy:It appears, for example, that breastfeeding causes changes in the endometrium that are similar to the changes brought about by the use of emergency contraception. If such changes can have an abortifacient effect in the former case, then there is no reason to think they cannot also have an abortifacient effect in the latter. But no one takes this to be a reason not to breastfeed...A breastfeeding woman does not intend the death of any particular fetus by breastfeeding. Even if there is an extremely rare risk of this occurring, it will occur only as a wholly unwanted side effect of her action...
She then deals, in conclusion, with the problem of proportionality:One might object that such a good [preventing pregnancy], while important, could never be proportional to the foreseeable possibility of the harm of the possible abortifacient effect. If the embryo really is a person with moral rights, perhaps only the risk of the mother’s death would be proportional to the foreseeable possibility of the death of the embryo. But this doesn’t seem right. Even on the interpretation of the empirical facts most favorable to opponents of emergency contraception, the chance that it will result in the death of an embryo, in any particular case, is very small.
In essence, "I claim that women who use emergency contraception need only intend the contraceptive effect of the medication, and not any possible abortifacient effect it may have."
The business of the broken sleep is interesting, but the business of sleep generally is interesting. I once did without it almost all the time for several weeks. I had high fever and was taking cortisone in big doses, which prevents your sleeping. I was starving to go to sleep. Since then I have come to think of sleep as metaphorically connected with the mother of God. Hopkins said she was the air we breathe, but I have come to realize her most in the gift of going to sleep. Life without her would be equivalent to me to life without sleep, and as she contained Christ for a time, she seems to contain our life in sleep for a time so that we are able to wake up in peace.
The reason it rung the bell for me is that when I have trouble sleeping, I head for the rosary. Well, more accurately, I start saying Hail Mary's. Holding the beads doesn't help. I'm usually too tired to keep track of which bead I'm on in which decade, so I just jump in with "Hail Mary, etc." and keep going. (I've more than once realized that I've said several Hail Mary's while still holding on to the same bead, so I have to start over.) I do try to think of a few intentions beforehand so that I'll feel like I'm doing something more important than counting Mary's in lieu of sheep. I'll just have to trust that the Lady doesn't mind. After all, she gave the idea for the rosary to some saint way back when, it's repetitious by nature, so she can't complain if people use it as a sleep-aid. It was her idea. Plus, the only reason it ever occurred to me to use it that way is that she once rocked baby Jesus to sleep, so I figure she can do the same for me. Rocking is repetitious, but so are the good habits that end in virtue. (So they tell me, not having gotten that far.)