{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:22:49Z","timestamp":1758759769001,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"accepted":{"date-parts":[[2017,7,16]]},"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:p>The doctrine of double effect (DDE) is a principle of crucial importance in law and medicine. In medicine, the principle is generally accepted to apply in cases where the treatment necessary to relieve pain and physical suffering runs the risk of hastening the patient\u2019s death. More controversially, it has also been used as a justification for withdrawal of treatment from living individuals and physician-assisted suicide. In this paper, I will critique the findings of the controversial Victorian Civil and Administrative Tribunal (VCAT) hearing <jats:italic>Syme vs the Medical Board of Australia<\/jats:italic>. In that hearing, Dr Rodney Syme, a urologist and euthanasia advocate, was defending his practice of prescribing barbiturates to terminally ill patients. Syme claimed that he prescribed the drugs with the intention of relieving their existential suffering and not to assist in suicide; he argued that the DDE could be applied. <jats:italic>Pace<\/jats:italic> VCAT, I argue that this is an illegitimate application of DDE. I argue that a close scrutiny of Syme\u2019s actions reveals that, at the very least, he intended to give patients the option of suicide. He furthermore used what on a traditional definition of DDE would be considered a \u2018bad\u2019 means\u2014the prescription of Nembutal\u2014to achieve a \u2018good\u2019 end\u2014the relief of suffering. The case demonstrates the crucial importance of analysing an agent\u2019s \u2018intention\u2019 and the \u2018effects\u2019 of their actions when applying DDE. Ethicists and, indeed, the judiciary need to attend to the ethical complexities of DDE when they assess the applicability of DDE to end of life care. If they fail to do this, the doctrine risks losing its legitimacy as an ethical principle.<\/jats:p>","DOI":"10.1136\/medethics-2017-104230","type":"journal-article","created":{"date-parts":[[2017,9,12]],"date-time":"2017-09-12T20:40:24Z","timestamp":1505248824000},"page":"266-269","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Does the doctrine of double effect apply to the prescription of barbiturates? <i>Syme vs the Medical Board of Australia<\/i>"],"prefix":"10.1136","volume":"44","author":[{"given":"Xavier","family":"Symons","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,9,12]]},"reference":[{"key":"2025092415191982000_44.4.266.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7309.388"},{"key":"2025092415191982000_44.4.266.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03550230075041"},{"key":"2025092415191982000_44.4.266.3","doi-asserted-by":"crossref","unstructured":"Syme vs medical board of Australia (review and regulation), VCAT 2150. 2016.doi:10.1002\/9781119127437.ch102","DOI":"10.1002\/9781119127437.ch102"},{"key":"2025092415191982000_44.4.266.4","unstructured":"Beauchamp TL , Childress JF . Principles of biomedical ethics. 6th edn: Oxford university press, 2009."},{"key":"2025092415191982000_44.4.266.5","unstructured":"McIntyre A . Zalta EN , Doctrine of double effect: The stanford encyclopedia of philosophy, 2014. https:\/\/plato.stanford.edu\/archives\/win2014\/entries\/double-effect\/"},{"key":"2025092415191982000_44.4.266.6","unstructured":"Bennett J . The act itself. London: Oxford university press, 1995."},{"key":"2025092415191982000_44.4.266.7","unstructured":"Uniacke S . The doctrine of double effect. In: Ashcroft R , Dawson A , Draper H , eds. Principles of health care ethics. 2nd edn. Hoboken: Wiley, 2007:1052\u20137."},{"key":"2025092415191982000_44.4.266.8","unstructured":"Cormick RR . Ambiguity in moral choice. In: Robert C , Kaczor CR , eds. marquette university press. Milwaukee: religious studies, 2000:252\u20133."},{"key":"2025092415191982000_44.4.266.9","doi-asserted-by":"crossref","first-page":"480","DOI":"10.5694\/mja14.01743","article-title":"A minimalist legislative solution to the problem of euthanasia","volume":"202","author":"Komesaroff","year":"2015","journal-title":"Med J Aust"},{"key":"2025092415191982000_44.4.266.10","unstructured":"For an overview of these debates. Woodward PA , ed. The doctrine of double effect: philosophers debate a controversial moral principle. Indiana: notre dame, 2001."},{"key":"2025092415191982000_44.4.266.11","unstructured":"Tobin B . VCAT\u2019s Syme ruling crucial to Victoria\u2019s euthanasia debate. The Australian, 2017. http:\/\/www.theaustralian.com.au\/news\/inquirer\/vcats-syme-verdict-crucial-to-victorias-euthanasia-debate\/news-story\/63da2ea0113c86b8bcec53d68c4084f3"},{"key":"2025092415191982000_44.4.266.12","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1849"},{"key":"2025092415191982000_44.4.266.13","doi-asserted-by":"publisher","DOI":"10.1177\/0269216309107024"},{"key":"2025092415191982000_44.4.266.14","doi-asserted-by":"publisher","DOI":"10.1136\/jme.2007.020446"},{"key":"2025092415191982000_44.4.266.15","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2013-101379"},{"key":"2025092415191982000_44.4.266.16","first-page":"376","article-title":"Voluntary palliated starvation: a lawful and ethical way to die?","volume":"22","author":"White","year":"2014","journal-title":"J Law Med"},{"key":"2025092415191982000_44.4.266.17","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1849"},{"key":"2025092415191982000_44.4.266.18","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(09)70032-4"},{"key":"2025092415191982000_44.4.266.19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2005.00888.x"}],"container-title":["Journal of Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/medethics-2017-104230","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T22:19:28Z","timestamp":1758752368000},"score":1,"resource":{"primary":{"URL":"https:\/\/jme.bmj.com\/lookup\/doi\/10.1136\/medethics-2017-104230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,12]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,3,22]]},"published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1136\/medethics-2017-104230"],"URL":"https:\/\/doi.org\/10.1136\/medethics-2017-104230","relation":{},"ISSN":["0306-6800","1473-4257"],"issn-type":[{"type":"print","value":"0306-6800"},{"type":"electronic","value":"1473-4257"}],"subject":[],"published":{"date-parts":[[2017,9,12]]}}}