 institution. Conversely, the avoidance of some harms may be inevitably bound up with incurring other harms. For example, the decision to refrain from inviting a very influential but controversial politician might end up harming the institution's ability to win favors from the state's legislature. In short, our real world is full of instances in which we cannot pursue the good that we ought to pursue, without at the same time running the risk of incurring certain evils that we ought to 2010] 271 JOURNAL OF CATHOLIC LEGAL STUDIES [Vol. 49:253 avoid. Conversely, it is full of instances in which we cannot avoid the evils we ought to avoid, without at the same time running the risk of incurring still further evils. St. Thomas Aquinas famously recognized the moral difficulties that arise when our pursuit of good is bound up with causing evil. Thus, as Aquinas observed, it is possible for one act to have two different effects. For example, the act of selfpreservation may have two different effects: the saving of one's life, which is the directly intended effect, and the slaying of an aggressor, which is an indirect or unintended effect.31 On Aquinas's account-which has come to be known as "the doctrine of double effect"-an act which has self-preservation as its direct and intended object is not necessarily an illicit act, even if the successful achievement of its object is inseparable from the causing of some evil.3 2 The act of saving one's own life, however, may become illicit, and thus not morally permissible, if the actas Aquinas says-is "out of proportion" to its proper end.33 The act would be "out of proportion" if, for example, the individual were to use excessive force in the otherwise legitimate act of selfdefense-for example, if the individual were to use lethal force in order to preserve his or her life, when lesser, non-lethal force would have been sufficient to achieve the same result of selfpreservation.34 A person may be morally justified in pursuing the intended good, even if securing the intended good cannot be achieved without the foreseen but unintended causing of some harm or evil. One is not justified, however, in securing the intended good by incurring the cost of the unintended evil or harm if there is no proper proportionality between the goodness of the intended good and the badness of the unintended evil or harm. Oncologists
institution. Conversely, the avoidance of some harms may be inevitably bound up with incur early harms. For example, the decisiveness to refrain from receive a very influential but controversial politician might end up harming the institution's ability to acquire favors from the state's legislature. In inadequate, our real world is wide of instances in which we cannot pursue the commodity that we ought to pursue, without at the same meter running the risk of incur certain evils that we ought to 2010 ] 271 JOURNAL OF CATHOLIC LEGAL STUDIES [ Vol. 49:253 avoid. Conversely, it is wide of instances in which we cannot avoid the evils we ought to debar, without at the same time running the risk of incurring however further evils. St. Thomas Aquinas famously recognized the moral difficulties that arise when our pursuit of good is bound up with causing evil. Thus, as Aquinas observed, it is possible for one act to have two different effects. For example, the act of selfpreservation may suffer two different effects: the preservation of one's life, which is the directly intended effect, and the murder of an aggressor, which is an collateral or unintended effect.31 On Aquinas's account - which has come to be known as " the doctrine of bivalent effect"-an act which has self - preservation as its direct and intended object is not necessarily an illegitimate act, even if the successful achievement of its object is inseparable from the causing of some evil.3 2 The act of saving one's own life, however, may become illicit, and thus not morally permissible, if the actas Aquinas says - is " out of symmetry " to its proper end.33 The act would be " out of symmetry " if, for case, the individual were to use excessive force in the differently legitimate act of selfdefense - for example, if the individual were to use lethal force in order to preserve his or her life, when less, non - lethal force would have been sufficient to achieve the like result of selfpreservation.34 A person may be morally justified in pursuing the intended commodity, even if securing the intended commodity cannot be achieved without the foreseen but unintended causing of some harm or evil. One is not justified, however, in securing the intended commodity by incurring the cost of the unintended evil or harm if there be no proper proportionality between the goodness of the intended good and the badness of the unintended evil or injury. Oncologists
 indtitution. Conversely, the avoidance of some harks may be inevktably bound up with incurriig orher yarms. For example, the aecision no refraib frin inviting a very lufluehbial yuv controversial politiciat might end up hxrling the institution's ability to wig favorx vrom the state'f lebyslaflrt. In short, our real world is full of insuances in which we cannot pursue the good thwt wf ought to pursue, aithout at jge fqme time runving the rpvk of incutring certain evils that we oughg to 2010] 271 JOURNAL IF CAHVOLIC LEGAL STUDPES [Vol. 49:253 avoid. Convervely, it is full of inxtaices in which we cannot atoid the evils we oudht to avmib, without at the same tume ronninc thd rirk kf ihcurrijg atill furtger evils. Sr. Thomas Aquinas fakotwly recognizes the iowal difficulties that arise when our pugsuif of good is bound up wuth causing evil. Thus, as Aquinws observed, it is possible for one act to have twm difhefenu cnfecgw. Vor example, the act of selfpreservation may hwbe teo different enfects: the saving pf omg's life, which ks the didectly intended efvect, anq the slaying jf am aggressor, which is an indurect or uniutebded effect.31 On Aqunnas's accounc-which has vome to be known as "the docfrine of dokble effedg"-an act which har svlf-pseservation as its direct wnd intenved oyject is not necesfarily an lllicld act, even if the duccedsxul achievfment of its object is inseparauke from the vagsitg of soie evll.3 2 The act of faving one's owu life, hjwevef, may becoje illirit, and thus not morally [grmissible, if the actws Awuinqs says-kr "out of propottion" to ptf priper end.33 The act wpula be "out of propirtuon" if, for examlle, thq pndmviduwn were to usa exzesrove furce in the uthetwise legitimate act of aelfdefense-for exakpje, if thg individtal were to uxe lethal force in ordec to pceservr hys or her life, when lesser, non-methal fogce would have feen sufficient co achieve the same result of selfpresertation.34 A person may be norally justified iu kursuing the mntendqd good, eeen if securing the untended good cankot be achieved withouf the xoresfen but unintended causing of some harm or evil. One is not justified, howecer, in securing ths inyendeg yoob by insurrmnj the cost of the unintended evil or harm if thece is no pso'er proportionality between tne goodness of jhe intended good and the gadness pf the unintended evil or harm. Pncologists
institution. Conversely, the avoidance of some harms inevitably up with other harms. For from a very influential controversial politician might up harming the institution's ability to favors from the state's legislature. In short, our real world is full of in which we cannot pursue the good that we ought to pursue, without the time the of incurring certain evils that we ought to 2010] 271 JOURNAL OF CATHOLIC LEGAL STUDIES [Vol. avoid. Conversely, it is full of instances in we cannot avoid the we ought to avoid, without the time running risk incurring further evils. St. Aquinas famously recognized the moral difficulties that arise when our pursuit of good is bound up with evil. Thus, observed, it possible one to have two For example, the act of selfpreservation different effects: the saving of one's life, which the directly effect, and the slaying of an which is an indirect or unintended effect.31 On account-which has come to be known as "the doctrine of double effect"-an act which has its direct and intended is not necessarily illicit even the achievement of object is inseparable from the causing of some evil.3 2 The of saving one's own life, however, may become illicit, and morally if the actas says-is "out of proportion" its end.33 The act would of if, individual to excessive force in the legitimate act of selfdefense-for example, the individual were to to preserve his or her life, when lesser, force would have been sufficient to achieve same result of selfpreservation.34 A person may be morally justified in pursuing intended good, securing the intended good cannot be achieved without foreseen but unintended causing some harm or evil. One is not justified, however, securing intended good incurring the cost the unintended evil harm if there proper proportionality the of and the badness of the unintended or Oncologists
 institution. Conversely, the aVoidance of Some hArmS maY bE ineVitaBly bound up with INcurRing other harms. For exampLe, the DeCIsioN To RefraIn from iNViTINg a VeRy InfLuENtIal buT coNtroverSial politiCiaN mIght end up harMInG the institUtiOn's ability to Win Favors FrOm tHE statE's lEgislAture. IN Short, oUr real worLd IS full oF InstancES In WhicH we cannot pursue thE GoOD that we ought to Pursue, WiTHoUT At tHe sAme time runNiNg the RIsk of inCUrRING ceRTain evils that We ought to 2010] 271 JOurNAl OF CAThOlIC leGAL STuDIES [voL. 49:253 AvoId. ConverselY, it iS full of inStanceS In which WE cannot Avoid tHe eVilS we oUGhT tO avOiD, WitHOuT at THe sAme time rUnNiNg the Risk OF INCurrIng StilL furtHer evils. St. ThoMas aquiNAs fAmousLy recOgniZeD the mOral diFficuLtIes that arise wheN our Pursuit of GooD iS boUnD up wiTH causiNg eVil. thus, as AQuinas oBSerVeD, IT Is Possible for one act tO hAVE tWo differEnt effECtS. FOR example, ThE acT of sELFpresErvaTIoN may have Two difFErEnT effectS: tHe saviNg Of oNe's Life, wHIch iS the diRectly inTendeD Effect, and the slAYing of an aggreSSoR, WHiCH is aN inDirect or uniNtenDEd efFect.31 oN AQuiNAs's acCount-WhICh HAs come to be known as "thE dOctrinE of doUble effect"-an aCt which has SELF-preservAtioN As ITs direct and intEnded Object is noT NecessarIly an Illicit aCt, even if tHE SuccessfUl aChiEveMenT OF iTs object is insEPArabLe From the CauSing of sOme EviL.3 2 ThE acT oF saving onE's own lifE, hOwEvEr, May BecomE Illicit, aNd ThuS nOt mOrallY PermisSible, If thE aCtAS AqUinas saYS-iS "OUt of PrOpOrtiOn" tO iTs proPer eND.33 ThE act wouLd be "out of ProPOrtiOn" If, For examPle, the individUaL were to use ExCesSive foRCE in the otHerwise legitimate act of sELfdefenSe-fOr exaMple, If the indiVidUal werE to USe lethAl forcE in orDeR to PREservE HIs Or hEr Life, when leSSEr, nOn-letHaL forCe would Have been sufficient TO acHieve the same rEsuLt of SELfPreSErVAtiOn.34 a PerSON may be morally juStified in pUrSUiNg the intenDEd gOoD, even if SecurinG the iNTended gOod cannot Be achieveD wIthoUT The Foreseen buT unintenDed causinG Of somE HaRm or eVil. one is nOt JusTifieD, howevER, in SecurIng the InTended Good bY iNcurring The cost of the unintended eVil or hArm if TheRe is no proPer PRopOrtionaliTy beTween the goOdnEss Of the IntENded gOod aND tHe bADness Of thE UnintendeD EvIl oR HArM. OncologistS
 institution. Conversely,the avoida nce o f s ome  h arms  may  be inevitably boun d up with incurring ot her h ar m s. F o rexamp le, the de c i sio nto  re fr a in  from  in vitinga very inf lue nt ial but cont r ov ersial pol iti cian might e ndup har mi ngt he in sti tutio n's ab i lity t o win fav or s  fromt he stat e ' slegi slature. In short ,  o u r real world i s full  o f  i n s tan ces  in whichwe  cann o t pursu e  t h e goo d  that we ough t to pursue ,  wi thoutat  th e  sametimeru n nin g the riskof i ncurringcertai n  evilst hat weoughtto201 0] 2 7 1JO URN AL OFC AT HOL I C L EGAL STU DI ES  [Vol . 49 : 2 5 3  avo id.  Con verse ly, it is ful l o f in s tan ces i n whi ch w ecanno t avoi d the  e vils we ought t o av oid, with out  a t t he  same time r unn ing  the ri sk of i n cur ri n g st ill further evils.  S t .  T homas Aq uinasf am ou s ly recog ni zed  the m oraldiff i cu lties th at ari s ewh en ourpu rsuitof  go odis bo u nd u p with  causing  evil .  Thus, as Aqui n as observed,i ti s  p o ssib lefor one act  toh avetwod if fer e nt ef fects .F or example, the act of  s elfpre serva tion may have  two diffe r e n t effect s: t h es aving of one's  life , which is the dire ctlyintended  effect,a n d the sl ayi ngofana g gr essor, whichi s  anin directoruninten ded  ef fec t.3 1On Aquina s's acco un t- wh ic h h as co m e to bekn own  a s " the d o ctrine  of d oubl eef f ect "-an ac t  w h i ch h as  s elf- pre se rvati on a s  it s direc t and int end e d ob je ct  is not  necessarilyan  illicit a ct , e ven if t he succe ssful achievement of it s  object  is  inse para ble fromthe  causi ngo f some  evil. 3 2 T he  ac t of sa v i ng  on e' s own life , how ever,  m ay b ecome i llicit, and thus n o t m orally permis sib le,i f  t hea ct a s A qu i nas s ays-is "out ofproportion "t oits proper end .3 3 The a ct woul d be" out ofproportio n" if, fo rexam p l e,the indivi dual wer e to usee xcess i ve  forc e i n theot her wiselegiti m ate  actof sel fd efense -forex ample, i f the individual were t o useletha l f orce in o rde r  to  preserve  his  or her li fe,  wh en le sse r , non -let h al  fo r ce wo uldh ave beens uf fic i e nt  to achieve t h e s ame r esu l t of s elfp reservation.34 Ap erson may be m oral l y  ju sti f iedin  pursuing theint en d e d good,ev en if secur ing thein t ended  goodcannot  be ach i e ve d  witho ut t heforeseenbut  u n intende dca u sing o f so me  harmor evi l . On e is not justified , how e v er, i n  se curin gthe int e nded  good by i ncurring th e cost  ofthe u nintend ed  evilorha rm if ther e  is no pr operproport io nali tybetwee n th e goodn essof  th e intende d go o dan d  th e ba dness  o f th e uninten d ed evilorh arm. On co log i s ts
 institution._Conversely, the_avoidance of some harms_may be_inevitably_bound up_with_incurring other harms._For example, the_decision to refrain from_inviting a very_influential_but controversial politician might end up harming the institution's ability to win favors from_the_state's legislature._In_short,_our real world is full_of instances in which we_cannot pursue_the good that we ought to pursue, without_at_the same time_running the risk of incurring certain evils that we_ought to 2010] 271 JOURNAL OF_CATHOLIC LEGAL STUDIES_[Vol._49:253_avoid. Conversely, it is_full of instances in which we_cannot avoid the evils we ought_to avoid, without at the same time_running the risk of incurring still_further evils. St. Thomas Aquinas_famously recognized_the moral difficulties that arise_when our pursuit_of good_is bound up_with causing evil. Thus, as Aquinas_observed, it is_possible for one act to have_two_different effects. For_example,_the_act of_selfpreservation may have_two_different effects:_the_saving of one's life, which is_the_directly intended effect, and the slaying of_an aggressor, which is_an_indirect or unintended effect.31_On Aquinas's account-which has come_to be known as "the doctrine_of double_effect"-an act_which has self-preservation as its direct and intended object is not_necessarily an illicit act, even if_the successful achievement of_its object_is_inseparable from the_causing_of some_evil.3 2 The act of saving one's_own life,_however, may become illicit, and thus_not morally permissible, if_the_actas Aquinas says-is "out of proportion"_to its proper end.33 The act_would be "out of proportion"_if,_for_example, the individual were to_use excessive force in the otherwise_legitimate act of_selfdefense-for example, if the individual were to_use_lethal force in order to preserve_his_or her life, when lesser, non-lethal_force_would_have been sufficient to achieve_the same result of selfpreservation.34 A_person may be morally justified in pursuing the intended_good, even if_securing the intended good cannot_be_achieved_without the foreseen but unintended causing of some harm or_evil. One_is not justified,_however, in securing the intended good by incurring the cost_of the unintended evil or harm if_there is no proper proportionality between the goodness of the intended_good and the badness of the unintended evil_or harm. Oncologists