Double Effect - Morally Evil Means

I was reading Alison McIntyre on DE (Double Effect) and the DDE (Doctrine of Double Effect) and the following struck me: there is some slippage into equivocation when it comes to moral evils and physical evils.

Effects of an intentional act may be non-harmful (pleasant/useful/etc.) or harmful, and means employed may likewise be harmful or non-harmful. But harmful means should not be identified with morally evil means. Alison McIntyre claims that the DE “expresses a prohibition on harm intended as a means to a good end.”[1] Under this interpretation of the DDE, “instrumental harming”[2] is prohibited. However, the classical formulation of the DDE certainly permits instrumental physical harm: what is prohibited is the use of morally evil means. The surgeon causes harm by slicing into human flesh to effect a good result – and yet this does not constitute morally bad means unless one grants that physical harm is the equivalent of a moral evil.

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[1] Alison McIntyre, “Doing Away with Double Effect,” Ethics 111, no. 2 (January 2001): 219-55.

[2] Ibid.          

So. There.