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)

This paper argues that practical reasoning is a mental process which leads a person from a set of existent mental states to an intention. In Section 1, I defend this view against two other proposals according to which practical reasoning either concludes in an action itself or in a normative belief. Section 2 discusses the correctness of practical reasoning and explains how the correctness of instrumental reasoning can be explained by the logical relations that hold between the contents of the (...) mental states. In Section 3, I explore the correctness of normative practical reasoning. I conclude with the sceptical view that correct practical reasoning cannot require us to intend to do what we believe we ought to do. (shrink)

This article focuses on the ethical implications of so-called ‘collateral damage’. It develops a moral typology of collateral harm to innocents, which occurs as a side effect of military or quasi-military action. Distinguishing between accidental and incidental collateral damage, it introduces four categories of such damage: negligent, oblivious, knowing and reckless collateral damage. Objecting mainstream versions of the doctrine of double effect, the article argues that in order for any collateral damage to be morally permissible, violent agents must comply with (...) high standards of care. In order for incidental harm to be permissible, an agent must take pains to avoid such harm even at higher cost to him- or herself. It is argued that accidentally but negligently caused collateral damage may be just as difficult to excuse as incidental harm. Only if high precautionary standards of care are met, can unintended harm to innocents – incidental or accidental – be permissible. In practice, such a strong commitment to avoiding harm to civilians may well lead us to question more generally and rethink more radically how violent conflicts ought to be fought, how military violence ought to be used and whether there are better ways of achieving those aims that we think are legitimate than those we are currently using. (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)

This paper deals with the core version of the Trolley Problem. In one case many people favor an act which will bring about the death of one person but save five other persons. In another case most people would refuse to “sacrifice” one person in order to save five other lives. Since the two cases seem similar in all relevant respects, we have to explain and justify the diverging verdicts. Since I don’t find current proposals of a solution convincing, I (...) propose an alternative one according to which —but not —violates two forms of equality. I also test the underlying egalitarian principle against other cases. I argue that it offers a good explanation and also a normative justification of our intuitive verdicts about the cases. (shrink)

The classical principle of double effect offers permissibility conditions for actions foreseen to lead to evil outcomes. I shall argue that certain kinds of closeness cases, as well as general heuristic considerations about the order of explanation, lead us to replace the intensional concept of intention with the extensional concept of accomplishment in double effect.

Recently, much attention has been paid to ‘rational requirements’ and, especially, to what I call ‘rational requirements of formal coherence as such’. These requirements are satisfied just when our attitudes are formally coherent: for example, when our beliefs do not contradict each other. Nevertheless, these requirements are puzzling. In particular, it is unclear why we should satisfy them. In light of this, I explore the conjecture that there are no requirements of formal coherence. I do so by trying to construct (...) a theory of error for the idea that there are such requirements. (shrink)

The difficulty of distinguishing between the intended and the merely foreseen consequences of actions seems to many to be the most serious problem for the doctrine of double effect. It has led some to reject the doctrine altogether, and has left some of its defenders recasting it in entirely different terms. I argue that these responses are unnecessary. Using Bratman’s conception of intention, I distinguish the intended consequences of an action from the merely foreseen in a way that can be (...) used to support the doctrine of double effect. (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 series of 'trolley' examples issue a challenge to moral principles based on intentions, since it seems that these give the wrong answers in two important cases: 'Fat Man', where they seem to say that it is permissible to push someone in front of a trolley to save others, and 'Loop', where they seem to say that it is wrong to divert a trolley towards a single person whose body will stop it and save others. I reply, first, that there (...) is a parallel between the wrongful intention to mutilate in 'Transplant', where one person's vital organs are removed to save others' lives, and the intention to assault in Fat Man. Secondly, I defend Frances Kamm's view that in Loop one can divert the trolley towards the one without an intention to kill or assault, since good potential side-effects can be taken into account in deciding what to do, without their becoming intentions. (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)

Thought: A Journal of Philosophy, EarlyView.

The orthodox account of the morality of war holds that the responsibility for resorting to war rests on the state’s political authorities and the responsibility for how the war is waged rests only on the state’s army and, thus, business firms have no special obligations in wartime. The purpose of this article is to reconsider the ethical responsibilities of business firms in wartime. I defend the claim that a plausible standard of liability in war must integrate the degree of the (...) agent’s contributions to posing an unjust threat, the nature of agent's behavior, and his/her intentions. If these premises are correct, it follows that the moral obligations of civilians and business corporations are fundamentally altered by war. Taking into consideration their relative contributions to the war effort, a taxonomy of business firms is developed. (shrink)

This article treats recent bioethical discussions of double effect reasoning (DER), offering a summary account of DER and construing it as rooted in a sensible view of what is central to someone's identity as a moral agent. It then treats objections raised in recent years by Judith Thomson, Alison McIntyre, and Frances Kamm against familiar ways of applying DER to certain controversies within medical ethics, especially, that over physician-assisted suicide. After detailing, interpreting, and attempting to rebut the challenges from these (...) philosophers, who are especially interesting because their criticisms of DER come from allies in DER's struggle against consequentialist reasoning, the essay engages DER's contribution to a recent dispute over treatment of patients in what is called ‘persistent vegetative state.' Near its end, the paper sketches several possible points of entry to DER and sources of justification for it. The essay concludes by indicating a connection between these paths and its opening idea of moral identity. (shrink)