Given the wide the range of legally available options for end-of-life care in recent decades: from aggressive, even experimental, treatment to active euthanasia, our ethical analysis struggles to keep pace with technology and law. In this essay I show that the principle of double effect (PDE) remains, and will continue to be, a useful tool for ethical analysis of end-of-life care. According to PDE, an agent may ethically perform an act that s/he foresees will have a significant bad effect (e.g., (...) death) in addition to a good effect (e.g., pain relief) only if s/he does not intend the bad effect, the act is not bad for reasons other than its causing the bad effect, and there is a proportionately serious reason to act. Following a brief explanation of PDE and preliminary considerations in favor of counting death as a bad effect, I analyze several end-of-life options in terms of the principle. I begin with those that enjoy significant consensus among proponents of PDE: active euthanasia, “passive euthanasia,” and palliative care. Then I consider the less-straightforward cases of drug provision, refusing food and water, and terminal sedation, arguing that participation in such actions is justifiable via PDE only under very limited conditions. (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)

There are different formulations of the doctrine of double effect, and sometimes philosophers propose “revisions” or alternatives, like the means principle, for instance. To demonstrate that such principles are needed in the first place, one would have to compare cases in which all else is equal and show that the difference in intuitions, if any, can only be explained by the one remaining difference and thus by the principle in question. This is not the methodology defenders of the DDE and (...) of related principles use, however. I will discuss how they actually proceed, focusing on their preferred four pairs of examples. While these examples might have rhetorical force, they are nevertheless philosophically and methodologically useless. As a corrective, I shall offer examples that do keep all else equal. These examples undermine the DDE and related principles. I then argue that while the Loop case and the “closeness” problem in the context of Jonathan Bennett’s Sophisticated Bomber example might once have been an embarrassment of sorts for defenders of the DDE, meanwhile their discussion serves as a convenient distraction from the many clear examples disproving the DDE and related principles. I conclude that the methodological mistakes found in defenses of the DDE – the biased framing, the rigged examples, the empirically unwarranted claims about how widely shared certain intuitions are, and the avoidance of the strongest counter-examples – can only be explained by systematic bias. There is simply no sufficient intuitive support for the DDE or related principles. Thus, instead of looking for their “rationales,” they should be abandoned. (shrink)