Philosophers debate over the truth of the Doctrine of Doing and Allowing, the thesis that there is a morally significant difference between doing harm and merely allowing harm to happen. Deontologists tend to accept this doctrine, whereas consequentialists tend to reject it. A robust defence of this doctrine would require a conceptual distinction between doing and allowing that both matches our ordinary use of the concepts in a wide range of cases and enables a justification for the alleged moral difference. (...) In this article, I argue not only that a robust defence of this doctrine is available, but also that it is available within a consequentialist framework. (shrink)

This thesis will utilise the literature on the distinction between doing harm and allowing harm to develop a novel system of moral sequencing that can be applied to general moral problems to decide if, when, and how an agent should intervene to prevent harm from occurring to another agent. Off the back of this discussion, this thesis will offer a way of determining the responsibility of certain agents for their actions within a moral sequence. These motivations will be at the (...) centre of the discussions in this thesis and will be accomplished by ultimately updating the system of moral sequencing so that it makes sense of practical cases of inner-agent change, which itself provides a justification for intervening earlier, and potentially diminishing the responsibility for agents who have experienced an inner-agent change, in a moral sequence. (shrink)

Negative duties are duties not to perform an action, while positive duties are duties to perform an action. This article focuses on the question of who holds the positive duties correlative to human rights. I start by outlining the Universal Scope Thesis, which holds that these duties fall on everyone. In its support, I present an argument by analogy: positive and negative duties correlative to human rights perform the same function; correlative negative duties are generally thought to be universal; by (...) analogy, we have reason to think that positive duties are held by everyone. I then consider three disanalogies that challenge the above argument. To address these worries, I introduce the notion of ‘aggregative duties’ – duties that can only be adequately grasped when we focus on the aggregate effect of the actions and omissions of different agents. This framework allows me to refine the initial thesis and address the objections. (shrink)

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis (...) is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment. (shrink)

With few exceptions, the literature on withdrawing and withholding life-saving treatment considers the bare fact of withdrawing or withholding to lack any ethical significance. If anything, the professional guidelines on this matter are even more uniform. However, while no small degree of progress has been made toward persuading healthcare professionals to withhold treatments that are unlikely to provide significant benefit, it is clear that a certain level of ambivalence remains with regard to withdrawing treatment. Given that the absence of clinical (...) benefit means treating patients is not only ethically questionable but also taxing on resources that could meet the needs of others, this ambivalence is troubling. Equally, the enduring ambivalence of professionals might be taken to indicate that the issue warrants further attention. In this paper, we review the academic literature on the ethical equivalence of withdrawing and withholding medical treatment. While we are not in outright disagreement with the arguments presented, we suggest that asserting theoretical and decontextualized claims about the ethical equivalence of withdrawing and withholding life-saving treatment does not fully illuminate the moral questions associated with the relevant clinical realities. We argue that what is required is a broader perspective, one rooted in an understanding that withdrawing and withholding life-saving treatment are different practices, the meanings of which are fully comprehensible only through an appreciation of their place within the practice of healthcare more generally. Such an account suggests that if one is to engage with the inappropriate protraction of life-saving treatment resulting from healthcare professionals’ disinclination to withdraw it, then the differences between these practices should be taken seriously. (shrink)