This article examines the relationship between the principle of double effect and justification for separation surgeries for conjoined twins. First, the principle of double effect is examined in light of its historical context. It is argued that it can only operate under an absolutist view of good and evil that is compatible with the Bible. Given this foundation for application, scenarios for separating conjoined twins are considered against the criteria for the principle of double effect. It is concluded that the (...) principle of double effect cannot be applied to cases wherein one of the twins must be killed. However, it is noted that this does not leave decision makers without options. (shrink)

The management of patients suffering from chronic disorders of consciousness inevitably raises important ethical questions about the end of life decisions. Some ethical positions claim respect of human life sacredness and the use of good medical practices require allowing DOC patients to live as long as possible, since no one can arbitrarily end either his/her or others’ life. On the other hand, some currents of thought claim respect of human life dignity, patients’ wishes, and the right of free choice entail (...) allowing the withdrawal of life sustaining therapy. This could happen when patients believe their own life to be not worth living, or if therapy is not very beneficial, excessively burdensome, or even futile. Indeed, the decision to withdraw therapies in a DOC patient should be guided by reliable information about DOC diagnosis and prognosis and on how the patient would wish to be treated in such a condition. Taking into account such issues, it would be possible to make the decision that more adequately fits a DOC patient’s best interest. This review aims to overview the range of ethical issues referring to end-of-life decisions in DOC patients, with regard to the thorny debate on the sacredness and dignity of human life. (shrink)

A common assumption within the migration ethics literature is that it is only states that have the power to admit foreigners to their territory. However, this assumption misses something important. While it is true that it is states that have the ultimate power to admit, other actors can possess a derivative power from the laws that states put in place. By establishing a system of work visas, for instance, states lend private corporations, and other employers, the power to nominate foreigners (...) for admission by making job offers. For many foreigners, a job offer is what they require to start a new life in a new country. The question then arises how corporations should use this derivative power? One might assume that they should use it as they typically do: to pursue their business interests and by doing so (we hope) benefit their stakeholders including the state and its citizens. However, could there not be other reasons, besides profit seeking, to offer refugees a visa-conferring job? If hiring refugees does not greatly harm their business, it is arguable that corporations could be obliged to use their derivative power to do so on humanitarian grounds. Moreover, some corporations also seem to be obliged to use this power on grounds of corrective justice. This paper advances these possibilities. It has three sections. First, I will look at how much discretion corporations have in terms of employment and migration laws in some European countries. Second, I will present an argument for why corporations are morally permitted to facilitate admission for refugees by offering them a visa-conferring job. In the final section, I will then defend a stronger claim, namely that corporations are possibly obliged to do so on humanitarian grounds or on grounds of corrective justice. (shrink)

The trolley problem, first described by Foot (1967) and Thomson (The Monist, 59, 204–217, 1976), is one of the most famous and influential thought experiments in deontological ethics. The general story is that a runaway trolley is threatening the lives of five people. Doing nothing will result in the death of those persons, but acting in order to save those persons would unavoidably result in the death of another, sixth person. It appears that, depending on the situation, we have different (...) moral judgments about the permissibility of action. We will review and systematize all the proposals in the literature of the past 35 years that have attempted to grasp our moral intuitions in a simple deontological principle. In particular, seventeen proposals will be classified: six algorithmic, seven psychological, and four other invalid accounts. This review and classification sheds light on some subtle differences and clarify a few issues. (shrink)

The use of terminal sedation to control theintense discomfort of dying patients appearsboth to be an established practice inpalliative care and to run counter to the moraland legal norm that forbids health careprofessionals from intentionally killingpatients. This raises the worry that therequirements of established palliative care areincompatible with moral and legal opposition toeuthanasia. This paper explains how thedoctrine of double effect can be relied on todistinguish terminal sedation from euthanasia. The doctrine of double effect is rooted inCatholic moral casuistry, but (...) its applicationin law and morality need not depend on theparticular framework in which it was developed. The paper further explains how the moral weightof the distinction between intended harms andmerely foreseen harms in the doctrine of doubleeffect can be justified by appeal to alimitation on the human capacity to pursue good. (shrink)

Trolley dilemmas have been tested cross-culturally, but only recently have researchers begun to assess the effect of responding to such dilemmas in a foreign language. Previous studies have found a Moral Foreign Language Effect in trolley dilemmas, whereby subjects who respond to these dilemmas in a foreign language, tend to offer more utilitarian responses. The present study seeks to test whether the MFLE holds amongst native speakers of Arabic. Additionally, the present study seeks to test whether the use of visual (...) images has any effect on responses. For such purposes, four groups were compared: 1) participants responding to trolley dilemmas in English without visual images; 2) participants responding to trolley dilemmas in Arabic without visual images; 3) participants responding to trolley dilemmas in English with visual images; 4) participants responding to trolley dilemmas in Arabic with visual images. (shrink)

In 1989, Thomas Donaldson requested the California courts to allow physicians to hasten his death. Donaldson had been diagnosed with brain cancer, and he desired to die in order to cryonically preserve his brain, so as to stop its further deterioration. This case elicits an important question: is this a case of euthanasia? In this article, we examine the traditional criteria of death, and contrast it with the information-theoretic criterion. If this criterion is accepted, we posit that Donaldson’s case would (...) have been cryocide, but not euthanasia. We then examine if cryocide is an ethically feasible alternative to euthanasia. To do so, we rely on the ethical doctrine of double effect. (shrink)

The doctrine (or principle) of double effect is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. According to the principle of double effect, sometimes it is permissible to cause a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a (...) means to bringing about the same good end. Does the principle of double effect play the important explanatory role that has been claimed for it? To consider this question, one must be careful to clarify just what the principle is supposed to explain. Three misinterpretations of the principle’s force or range of application are common. 1. To ensure that Double Effect is not misunderstood as principle issuing a blanket permission on causing any unintended harm that yields a benefit, applications must require that the agent seek to minimize the harm involved. 2. Since it is widely accepted that it is wrong to aim to produce harm to someone as an end, to rule this out is not part of double effect’s distinctive content. 3. Harms that were produced regretfully and only for the sake of producing a good end may be prohibited by double effect because they were brought about as part of the agent’s means to realizing the good end. (shrink)

. How does the doctrine of double effect apply to business decisions to sell products which may be harmful to consumers? Lawrence Masek believes that some authors have misapplied the doctrine to this type of decision and, as a consequence, have committed themselves to placing unwarranted constraints on businesses. Seeking to correct this mistake, Masek presents his account of how the doctrine applies here, an account which is rather permissive but which, he claims, nevertheless preserves the virtues of the doctrine. (...) It will be seen, though, that his attempt to loosen these putatively unnecessary constraints by appealing to consumer autonomy and an intuition about the morality of producing harmful products leaves the doctrine of double effect irrelevant to this type of decision. His argument that the doctrine is less restrictive in this context than others suppose leads ultimately to the conclusion that the doctrine does not constrain this kind of business decision at all. (shrink)

In John McDowell's recent Woodbridge Lectures at Columbia University, he characterizes Wilfrid Sellars's master thought, in Empiricism and the Philosophy of Mind, as drawing a line between two types of characterizations of states that occur in people's mental lives: Above the line are placings in the logical space of reasons, and below it are characterizations that do not do that (McDowell, 1998, p. 433). In this essay, I ask what would be required for ethics to be above the line. More (...) precisely, what would be necessary to characterize episodes as actions, and persons as agents, so as for them to be answerable to moral criticism in light of rationally relevant considerations. The requirements are twofold: that practical reason motivate in virtue of the content of its deliverances; and that there be a will which is sensitive to those deliverances, and which chooses freely. A widespread procedural account of practical reason is examined and found insufficient to place ethics above the line; and a suspicion is raised that McDowell himself, and Jonathan Dancy, do not have a robust enough conception of will to avoid the below the line ethics they accuse their opponents of defending. (shrink)

Many medical interventions have both negative and positive effects. When health care professionals cannot achieve a particular desired good result without bringing about some bad effects also they often rely on double-effect reasoning to justify their decisions. The principle of double effect is therefore an important guide for ethical decision-making in medicine. At the same time, however, it is a very controversial tool for resolving complex ethical problems that has been criticized by many authors. For these reasons, I examine in (...) this paper whether the principle of double effect can serve as a basis for ethical decisions in medicine. The conclusion reached in this article is that even though this principle has desirable effects on clinical conduct, it is only an unreliable guide and physicians and nurses cannot feel secure in continuing to use this principle for ethical guidance. (shrink)

The use of intention in ethics has been the subject of intense debate for many years, but no consensus has emerged over whether intention is morally relevant, or even how it should be understood. In this paper I wish to make a thorough, though by no means exhaustive, examination of the concept and the concepts around it, some to be seen as near-synonyms, and some as contrasting ideas. My interest is in the ethical use of the concept, though my own (...) analysis of it will be indebted to discussions in the philosophy of action. The most famous ethical use, which will not, however, be my direct focus here, is the ‘principle of double effect,’ which states that an agent may cause or allow something bad as long as, first, no evil is intended as an end or a means; and, second, that the foreseen bad is not out of proportion with the anticipated good. It is important to note the principle’s testimony to the plausibility of prohibitions expressed in terms of intentions, and, alongside these, a general prohibition on doing inordinate harms even without intention. (shrink)

The use of intention in ethics has been the subject of intense debate for many years, but no consensus has emerged over whether intention is morally relevant, or even how it should be understood. In this paper I wish to make a thorough, though by no means exhaustive, examination of the concept and the concepts around it, some to be seen as near-synonyms, and some as contrasting ideas. My interest is in the ethical use of the concept, though my own (...) analysis of it will be indebted to discussions in the philosophy of action. The most famous ethical use, which will not, however, be my direct focus here, is the ‘principle of double effect,’ which states that an agent may cause or allow something bad as long as, first, no evil is intended as an end or a means; and, second, that the foreseen bad is not out of proportion with the anticipated good. It is important to note the principle's testimony to the plausibility of prohibitions expressed in terms of intentions (indicated by the first condition), and, alongside these, a general prohibition on doing inordinate harms even without intention (indicated by the second condition). (shrink)

As media reports have made widely known, in November 2009, the ethics committee of St. Joseph’s Hospital in Phoenix, Arizona, permitted the abortion of an eleven-week-old fetus in order to save the life of its mother. This woman was suffering from acute pulmonary hypertension, which her doctors judged would prove fatal for both her and her previable child. The ethics committee believed abortion to be permitted in this case under the so-called principle of double effect, but Thomas J. Olmsted, the (...) bishop of Phoenix, disagreed with the committee and pronounced its chair, Sister Margaret McBride, excommunicated latae sententiae, “by the very commission of the act.” In this article, I take the much discussed Phoenix case as an occasion to subject the principle of double effect to another round of philosophical scrutiny. In particular, I examine the third condition of the principle in its textbook formulation, namely, that the evil effect in question may not be the means to the good effect. My argument, in brief, is that the textbook formulation of the principle does not withstand philosophical scrutiny. Nevertheless, in the end, I do not claim that we should then “do away” with the principle altogether. Instead, we do well to understand it within the context of casuistry, the tradition of moral reasoning from which it issued. (shrink)

ABSTRACTBusiness actors often act in ways that may harm other parties. While the law aims to restrict harmful behavior and to provide remedies, legal systems do not anticipate all contingencies and legal regulations are not always well-enforced. This article argues that the logic of double effect, which has been developed and deployed in other areas of practical ethics, can be useful in helping business actors decide whether or not to pursue potentially harmful activities in commonplace business activity. The article illustrates (...) how LDE helps to explain the exploitative nature of payday lending, the distinction between permissible and impermissible forms of market competition, and the potential wrong of imposing risk of harm on others. The article also addresses foundational debates about LDE itself. We offer the article as an illustration of the sort of “midlevel” theorizing that can address directly the needs of practitioners. (shrink)

T. M. Scanlon has argued that the intentions with which one acts, or more specifically, one’s reasons for acting, are non-derivatively irrelevant to the moral permissibility of one’s actions. According to one of his arguments in favor of that thesis, it can be permissible to act for one reason rather than another only if one can choose to act for a reason but, since that choice is impossible since believing as will is impossible, one can be permitted to act but (...) one cannot be permitted to act for a reason. This paper aims to show that that argument is unsound. It first argues that the assumption that choosing an action is necessary for it being an object of a moral duty or permission cannot be made consistent with Scanlon’s idea that the same does not hold for an action being an object of blame. It then argues that even if direct control over forming beliefs is impossible, it is not impossible to choose one’s reason for action and, therefore, to be permitted or forbidden to act for it. (shrink)

As we die, our respiratory pattern is altered and we seem to gasp and struggle for each breath. Such gasping is commonly seen as a clear sign of dyspnoea and suffering by families and loved ones, however, it is unclear whether it is perceived at all by the dying person. Narcotics and sedatives do not seem to affect these gasping respirations. In this issue of the Journal of Medical Ethics, we are asked to consider whether the last gasp of a (...) dying patient could be or, perhaps, even should be avoided by administering neuromuscular blockers to palliate dying patients. For many reasons, such as our current failure to alleviate pain and distress, stories of inadequate analgesia and sedation in critically ill paralysed patients and the inability to know the intent—whether to palliate or to euthanise—it would seem that administering neuromuscular blockers should not be ethically permissible. (shrink)

Criminal law theorists overwhelmingly agree that for some conduct to constitute punishment, it must be imposed intentionally. Some retributivists have argued that because punishment consists only of intentional inflictions, theories of punishment can ignore the merely foreseen hardships of prison, such as the mental and emotional distress inmates experience. Though such distress is foreseen, it is not intended, and so it is technically not punishment. In this essay, I explain why theories of punishment must pay close attention to the unintentional (...) burdens of punishment. In two very important contexts — punishment measurement and justification — we use the term “punishment” to capture not only intentional harsh treatment but certain unintentional harsh treatment as well. This means that the widely accepted view that punishment is an intentional infliction requires substantial caveats. It also means that any purported justification of punishment that addresses only the intentional infliction of punishment is woefully incomplete. -/- [This paper has been published under a Creative Commons Attribution-NonCommercial-ShareAlike license.]. (shrink)

This paper examines the dynamics of hostile takeovers as a form of corporate warfare. There are a number of compelling reasons for believing this to be an accurate approximation to corporate reality and therefore an appropriate analogy. In circumstances where it is all-too easy for either of the protagonists to act unethically, there is an evident need for an appropriate template through which to analyse and evaluate the ethical dilemmas that HT's inevitably raise —whilst also, where possible, employing its prescriptions (...) as a means of corporate conflict resolution. This paper evaluates just war theory as one such template. In seeking a conceptually adaptable framework for analysing, interpreting and articulating antagonistic behaviour during a HT, it became apparent in the course of the research that JWT provided a potentially useful and viable template within which to pursue the above. The research questions centre not necessarily on whether this template could in some way be a substitute for statutory and regulatory constraints on unethical conduct but, rather, whether it might better inform all stakeholders of the importance of ethically informed restraint in the interest of the greater good. (shrink)

This contribution is a report of a two months' participant observation in a Dutch hospice. The goal of the observation was to gain an overview of moral decisions in a hospice in which euthanasia, a tolerated practice in the Netherlands, is not accepted as an option. In an introduction, the development of palliative care in the Netherlands will be briefly presented. Subsequently, various moral decisions that were taken during the participant observation are presented and analysed by means of case reports. (...) Attention is especially drawn to decisions that directly or indirectly relate to euthanasia. These moral decisions will be clarified in the light of the philosophy behind the concept of palliative care as it has evolved since the foundation of St Christopher's Hospice, London in 1967. (shrink)

ZusammenfassungDem sogenannten Knobe-Effekt zufolge bestimmt die moralische Valenz von Nebeneffekten menschlichen Verhaltens die Zuschreibung ihrer absichtlichen Verursachung. Wir argumentieren, dass erstens die empirisch ermittelten sozialpsychologischen Daten den Knobe-Effekt in der üblichen Lesart nicht belegen, vor allem wegen der unvollständigen Untersuchung der entscheidenden moralischen Varianzfaktoren. Zweitens zeigen wir, dass - und wie - eine spezifische Version des traditionellen Prinzips des Doppeleffekts den empirisch bestätigten Teil des Knobe-Effekts philosophisch erklärt. Die Erklärungskraft des Prinzips des Doppeleffekts kann auch als eine Rechtfertigung eben dieses (...) Prinzips gesehen werden. (shrink)

In ordinary circumstances, human actions have a myriad of unintended and often unforeseen consequences for the lives of other people. Problems of pollution are serious examples, but spillovers and side effects are the rule, not the exception. Who knows what consequences this essay may have? This essay is concerned with the problems of justice created by spillovers. After characterizing such spillovers more precisely and relating the concept to the economist's notion of an externality, I shall then consider the moral conclusions (...) concerning spillovers that issue from a natural rights perspective and from the perspective of welfare economics supplemented with theories of distributive justice. I shall argue that these perspectives go badly awry in taking spillovers to be the exception rather than the rule in human interactions. I. Externalities Economists have discussed spillovers under the heading of “externalities.” To say this is not very helpful, since there is so much disagreement concerning both the definition and significance of externalities. (shrink)

Philosophers have long debated whether there is a morally significant difference between acting with the intention of bringing about some state of affairs and acting with the mere awareness that that state of affairs will occur as an unintended side effect of what one is trying to achieve. This controversy is mirrored in the criminal law in a number of places, most notably with respect to the question of whether the mens rea for the crime of murder should require the (...) intent to cause death or only the knowledge that it will occur. In this paper I propose what I believe is a satisfactory way of drawing the intended/foreseen distinction and then argue, contrary to what Duff and others have supposed, that such a distinction does not underwrite a difference in moral or legal culpability. I leave open the possibility, however, that there may be consequentialist reasons for sometimes imposing greater liability in the case of intended harms than in the case of those that are merely foreseen. (shrink)

A recent administrative law decision in Victoria, Australia, applied double effect reasoning in a novel way. Double effect reasoning has hitherto been used to legitimate treatments which may shorten life but where the intent of treatment is pain relief. The situation reviewed by the Victorian tribunal went further, supporting actions where a doctor agrees to provide pentobarbitone to a patient at some time in the future if the patient feels at that time that his pain is unbearable and he wants (...) to end his life. The offer to provide the drug was described as a palliative treatment in that it gave reassurance and comfort to the patient. Double effect reasoning was extended in this instance to encompass potentially facilitating a patient’s death. This extension further muddies the murky double effect reasoning waters and creates another challenge to this concept. (shrink)

Recent contributions to the literature on the topic of futility have focused primarily on two areas: 1) definitions of the term and 2) the suggestion that cardiopulmonary resuscitation may be futile in certain patients. This suggestion is based on “scientific” measures and analyses of outcomes, describing the low probability of success of CPR in patients over age 70, those with cancer, those with multiorgan failure, etc. The research reported suggests that with such patients the physician need not get the patient's (...) consent to withhold resuscitation; the physician need only inform either the patient or the surrogate that CPR will not be Instituted in the event of an arrest. (shrink)

Judith Jarvis Thomson has recently proposed a new argument for the thesis that killing the one in the Trolley Problem is not permissible. Her argument relies on the introduction of a new scenario, in which the bystander may also sacrifice herself to save the five. Thomson argues that those not willing to sacrifice themselves if they could may not kill the one to save the five. Bryce Huebner and Marc Hauser have recently put Thomson's argument to empirical test by asking (...) people what they should do in the new trilemma case, in which they may also sacrifice themselves. They found that the majority judge that they should either kill the one or sacrifice themselves; Huebner and Hauser argue that those numbers speak against Thomson's argument. But Thomson's argument was about the dialectical effect of the new trilemma on the traditional dilemma, rather than about the trilemma itself. Here I present the results of a study in which I asked subjects first what they should do in the trilemma and then what they should do in the traditional Trolley Problem. I found that, if asked first about the trilemma, subjects then have the intuition that killing the one in the traditional Bystander at the Switch is not permissible?exactly what Thomson's argument had predicted. (shrink)

I argue against the Doctrine of Double Effect’s explanation of the moral difference between terror bombing and strategic bombing. I show that the standard thought-experiment of terror bombing and strategic bombing which dominates this debate is underdetermined with regards to the agents’ psychologies: (a) if Terror Bomber and Strategic Bomber have the same causal beliefs, then why does Terror Bomber set out to kill the children? It may then be this unwarranted and immoral choice and not the Doctrine of Double (...) Effect that explains the moral difference; (b) if the two have different causal beliefs, then we can’t rule out the counterfactual that, had Strategic Bomber had the same beliefs as Terror Bomber, she would have also acted as Terror Bomber did. (shrink)

I defend the argument that if embryo loss in stem cell research is morally problematic, then embryo loss in in vivo conception is similarly morally problematic. According to a recent challenge to this argument, we can distinguish between in vivo embryo loss and the in vitro embryo loss of stem cell research by appealing to the doctrine of double effect. I argue that this challenge fails to show that in vivo embryo loss is a mere unintended side effect while in (...) vitro embryo loss is an intended means and that, even if we refine the challenge by appealing to Michael Bratman's three roles of intention, the distinction is still unwarranted. (shrink)

There are some interesting similarities between Aristotle’s ‘mixed actions’ in Book III of the Nicomachean Ethics and the actions often thought to be justifiable with the Doctrine of Double Effect. Here I analyse these similarities by comparing Aristotle’s examples of mixed actions with standard cases from the literature on double effect such as, amongst others, strategic bombing, the trolley problem, and craniotomy. I find that, despite some common features such as the dilemmatic structure and the inevitability of a bad effect, (...) Aristotle’s mixed actions do not count as cases justifiable through application of the Doctrine of Double Effect because they fail to meet the crucial necessary condition of the Doctrine according to which the bad effect can only be a merely foreseen side-effect and not an intended means. (shrink)

Ordinary Language Philosophy has largely fallen out of favour, and with it the belief in the primary importance of analyses of ordinary language for philosophical purposes. Still, in their various endeavours, philosophers not only from analytic but also from other backgrounds refer to the use and meaning of terms of interest in ordinary parlance. In doing so, they most commonly appeal to their own linguistic intuitions. Often, the appeal to individual intuitions is supplemented by reference to dictionaries. In recent times, (...) Internet search engine queries for expressions of interest have become quite popular. Apparently, philosophers attempt to surpass the limits of their own linguistic intuitions by appealing to experts or to factual uses of language. I argue that this attempt is commendable but that its execution is wanting. Instead of appealing to dictionaries or Internet queries, philosophers should employ computer-based linguistic corpora in order to confirm or falsify hypotheses about the factual use of language. This approach also has some advantages over methods employed by experimental philosophers. If the importance of ordinary language is stressed, the use of linguistic corpora is hardly avoidable. (shrink)

I analyse the relationship between the Doctrine of Double Effect and the Trolley Problem: the former offers a solution for the latter only on the premise that killing the one in Bystander at the Switch is permissible. Here I offer both empirical and theoretical arguments against the permissibility of killing the one: firstly, I present data from my own empirical studies according to which the intuition that killing the one is permissible is neither widespread nor stable; secondly, I defend a (...) normative principle according to which killing the one in Bystander at the Switch is not permissible. In conclusion, there just is no trolley problem. (shrink)

In this paper, I will present a Kantian revision of the Doctrine of Double Effect. In order to do so, I will explain the concept of jus in bello – focusing in particular on the distinction between intent and foresight. I will then argue that we ought to take an agency-inspired look at the DDE. Finally, I will conclude by arguing for my thesis that Boyle’s theory of agency, while good, needs to be revised in order to accommodate concerns stemming (...) from Kant’s Formula of Humanity… namely consent. (shrink)