Acute ethics: Risk assessment and the Doctrine of Double Effect in a referral to on-call urology

The Doctrine of Double Effect has been described as often used in medicine and surgery but is seldom described outside the palliative medicine context. This paper presents a possible clinically focussed illustration of the doctrine of double effect used in an acute urological setting. The authors describe the case of an elderly patient with significant dementia and haematuria who required anticoagulation. Implicit double effect reasoning may have helped the surgical team reach their initial decision with regard to a treatment plan, reconciling a duty to beneficence with a duty not to cause harm. This short case is offered as a stimulus for further discussion over the role of duty-based ethical reasoning in the acute surgical setting. It also highlights a possible need for more detailed case-analysis in identifying areas of interest in surgical ethics.