Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

The doctrine of double effect is a moral principle that distinguishes between harm we cause as a means to an end and harm that we cause as a side-effect. As a purely descriptive matter, the DDE is well established that it describes a consistent feature of human moral judgment. There are, however, several rival theories of its psychological cause. I review these theories and consider their advantages and disadvantages. Critically, most extant psychological theories of the DDE regard it as an (...) accidental byproduct of cognitive architecture. This may provide philosophers with some reason to question its normative significance. (shrink)

The paper outlines and explores a possible strategy for defending both the action/omission distinction (AOD) and the principle of double effect (PDE). The strategy is to argue that there are degrees of actionhood, and that we are in general less responsible for what has a lower degree of actionhood, because of that lower degree. Moreover, what we omit generally has a lower degree of actionhood than what we actively do, and what we do under known-but-not-intended descriptions generally has a lower (...) degree of actionhood than what we do under known-and-intended descriptions. Therefore, we are in general less responsible for what we omit than for what we do—which is just what AOD says. And we are in general less responsible for what we do under known-but-not-intended descriptions than for what we do under known-and-intended descriptions—which is just what PDE says. (shrink)

T. A. Cavanaugh defends double-effect reasoning (DER), also known as the principle of double effect. DER plays a role in anti-consequentialist ethics (such as deontology), in hard cases in which one cannot realize a good without also causing a foreseen, but not intended, bad effect (for example, killing non-combatants when bombing a military target). This study is the first book-length account of the history and issues surrounding this controversial approach to hard cases. It will be indispensable in theoretical ethics, applied (...) ethics (especially medical and military), and moral theology. It will also interest legal and public policy scholars. (shrink)

Proponents of double‐effect reasoning — relying in part on a distinction between intention and foresight — assert that it is worse intentionally to cause harm than to cause harm with foresight but without intention. They hold, for example, that terror bombing is worse than tactical bombing in so far as terror bombing is the intentional harming of non‐combatants while tactical bombing is not. In articulating the ethical relevance of the intended/foreseen distinction, advocates of double effect employ the Kantian end‐not‐means principle. (...) Jonathan Bennett has recently argued that this principle cannot ground the ethical relevance of the intended/foreseen distinction. He holds that the principle demands that one benefit others while double effect deals with acts that do not benefit others. Thus, he maintains, the intended/foreseen distinction does not have ethical import and double effect is not tenable. I argue for a reading of the end‐not‐means principle that grounds the ethical relevance of both the intended/foreseen distinction and double effect. (shrink)

Much of Roman Catholic discussion concerning bioethical controversies, such as the surgical removal of a life-threatening cancerous uterus when the fetus is not viable, has focused on the employment of double-effect reasoning. While double-effect reasoning has been the subject of much debate, this paper argues first, that there is a distinction between the intended and the foreseen; second, that this distinction applies to the contrasted cases in such a way as to categorize foreseen but not intended consequences; and third, that (...) this intended/foreseen distinction has essential ethical significance. (shrink)

The doctrine of double effect continues to be an important tool in bioethical casuistry. Its role within the Catholic moral tradition continues, and there is considerable interest in it by contemporary moral philosophers. But problems of justification and correct application remain. I argue that if the traditional Catholic conviction that there are exceptionless norms prohibiting inflicting some kinds of harms on people is correct, then double effect is justified and necessary. The objection that double effect is superfluous is a rejection (...) of that normative conviction, not a refutation of double effect itself. This justification suggests the correct way of applying double effect to controversial cases. But versions of double effect which dispense with the absolutism of the Catholic tradition lack justification and fall to the objection that double effect is an unnecessary complication. Keywords: double effect, intention, side effect CiteULike Connotea Del.icio.us What's this? (shrink)

Legal minds have utilized the principle of double effect as proposed by St. Thomas Aquinas for centuries to shape legal authority in cases where moral judgment and legal reasoning meet. The U.S. Supreme Court had uti­lized double-effect reasoning in the realm of self-defense cases. This article discusses more recent use of double-effect reasoning in the landmark Supreme Court case Vacco v. Quill and its companion case, Washington v. Glucksberg. Chief Justice William Rehnquist, writing for the Court in Vacco, introduced double-effect (...) reasoning to identify the distinctions between palliative care and assisted suicide in an effort to uphold the constitutionality of the ban on assisted suicide in New York. National Catholic Bioethics Quarterly 11.1 (Spring 2011): 41–48. (shrink)

One's conception of the conditions and applicability of the principle of double effect derive from one's broader convictions about moral methodology. Developed in a Catholic context which presumed the existence of moral absolutes, the principle of double effect was originally a conceptual tool to aid priests in being skilled confessors. In recent decades, as the practice of moral theology has become less connected with its earlier ecclesial and sacramental context, the principle of double effect has fallen into an epistemological crisis. (...) Contemporary moral theological discussion of the principle of double effect usually operates in one of the following four contexts: interpretation of Aquinas; in relation to manualist casuistry; as understood within proportionalist methodology; as defended within the new natural law methodology. The essay argues that juridically-oriented methodologies do not adequately sustain the principle of double effect. To be sustained, it must be viewed as a theological achievement based upon the meaning of our redemption in Christ and the concomitant possibilities regarding our actions in pursuit of our true good and true end. (shrink)

In this major new book, the internationally renowned thinker Jonathan Bennett offers a deeper understanding of what is going on in our own moral thoughts about human behavior. The Act Itself presents a conceptual analysis of descriptions of behavior on which we base our moral judgements, and shows that this analysis can be used as a means toward getting more control of our thoughts and thus of our lives.

The doctrine of double effect has a firm, respected position within Roman Catholic medical ethics. Neil M. Gorsuch, a judge on the U.S. Court of Appeals for the Tenth Circuit, believes that this doctrine also enjoys a central place within U.S. law. This essay examines and assesses Gorsuch’s thesis. National Catholic Bioethics Quarterly 11.1 (Spring 2011): 31–40.

The validity of the double effect doctrine is examined in euthanasia and abortion. In these two situations killing is a method of treatment. It is argued that the doctrine cannot apply to the care of the dying. Firstly, doctors are obliged to harm patients in order to do good to them. Secondly, patients should make their own value judgments about being mutilated or killed. Thirdly, there is little intuitive moral difference between direct and indirect killing. Nor can the doctrine apply (...) to abortion. Doctors kill fetuses as a means of treating the mother. They also kill them as an inevitable side effect of other treatment. Drawing a moral distinction between the direct and the indirect killing gives counterintuitive results. It is suggested that pragmatic rules, not ethics, govern practices around euthanasia and cause it to be more restricted than abortion. (shrink)

Our brains were designed for tribal life, for getting along with a select group of others and for fighting off everyone else. But modern times have forced the world’s tribes into a shared space, resulting in epic clashes of values along with unprecedented opportunities. As the world shrinks, the moral lines that divide us become more salient and more puzzling. We fight over everything from tax codes to gay marriage to global warming, and we wonder where, if at all, we (...) can find our common ground. (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)

The U.S. Supreme Court's majority opinion in Vacco v. Quill assumes that the principle of double effect explains the permissibility of hastening death in the context of ordinary palliative care and in extraordinary cases in which painkilling drugs have failed to relieve especially intractable suffering and terminal sedation has been adopted as a last resort. The traditional doctrine of double effect, understood as providing a prohibition on instrumental harming as opposed to incidental harming or harming asa side effect, must be (...) distinguished from other ways in which the claim that a result is notintended might be offered as part of ajustification for it. Although double effectmight appropriately be invoked as a constrainton ordinary palliative care, it is not clearthat it can be coherently extended to justifysuch practices as terminal sedation. A betterapproach would reconsider double effect'straditional prohibition on hastening death as ameans to relieve suffering in the context ofacute palliative care. (shrink)

The illusory appeal of double effect -- The significance of intent -- Means and ends -- Blame.

As medical technology advances and severely injured or ill people can be kept alive and functioning long beyond what was previously medically possible, the debate surrounding the ethics of end-of-life care and quality-of-life issues has grown more urgent. In this lucid and vigorous book, Craig Paterson discusses assisted suicide and euthanasia from a fully fledged but non-dogmatic secular natural law perspective. He rehabilitates and revitalises the natural law approach to moral reasoning by developing a pluralistic account of just why we (...) are required by practical rationality to respect and not violate key demands generated by the primary goods of persons, especially human life. Important issues that shape the moral quality of an action are explained and analysed: intention/foresight; action/omission; action/consequences; killing/letting die; innocence/non-innocence; person/non-person. Paterson defends the central normative proposition that ’it is always a serious moral wrong to intentionally kill an innocent human person, whether self or another, notwithstanding any further appeal to consequences or motive’. (shrink)

This classic work examines the issues surrounding military theory, war crimes, and the spoils of war from the Athenian attack on Melos to the My Lai massacre.

In her paper, “The Doctrine of Double Effect: Problems of Interpretation,” Nancy Davis attempts to find an interpretation of the means-end relationship that would provide a foundation for the Doctrine of Double Effect (DDE) and its reliance on the distinction between what an agent intends or brings about intentionally and what that agent merely foresees will result from his/her action, but does not intend (or bring about intentionally). Davis’s inability to find such an interpretation lessens the plausibility of the view (...) that theDDE is an acceptable moral doctrine. In the present paper, it is suggested that Davis’s inability to find an interpretation of the means-end relationship that will support the DDE results from her assumption that an agent must intend to produce whatever he/she produces intentionally. Borrowing an argument from Michael Bratman, this article shows that Davis’s assumption is false. Thatrealization paves the way toward a defense of the DDE. (shrink)

“Terminal sedation” refers to the use of sedation as palliation in dying patients with a terminal diagnosis. Although terminal sedation has received widespread legal and ethical justification, the practice remains ethically contentious, particularly as some hold that it foreseeably hastens death. It has been proposed that empirical studies show that terminal sedation does not hasten death, or that even if it may hasten death it does not do so in a foreseeable way. Nonetheless, it is clear that providing terminal sedation (...) in combination with the withholding or withdrawing of life-prolonging treatments such as fluid and nutrition can foreseeably hasten death significantly—what is here called early terminal sedation . There are ethical justifications for the use of sedation in palliative care and thus it would seem that ETS is an ethically and legally acceptable practice. However, what emerges from the literature is the repeated assertion that terminal sedation must be restricted to use in imminently dying patients—the “imminence condition”—and that therefore ETS is unacceptable. This restriction has taken on greater significance with the trend of palliative care to include the care of patients who are not imminently dying. This paper proposes to show that although there is widespread intuitive support for the imminence condition, it does not follow from the justifications for sedation as palliation, and that explicit arguments for the imminence condition are needed. (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)

The paper outlines and explores a possible strategy for defending both the action/omission distinction and the principle of double effect. The strategy is to argue that there are degrees of actionhood, and that we are in general less responsible for what has a lower degree of actionhood, because of that lower degree. Moreover, what we omit generally has a lower degree of actionhood than what we actively do, and what we do under known-but-not-intended descriptions generally has a lower degree of (...) actionhood than what we do under known-and-intended descriptions. Therefore, we are in general less responsible for what we omit than for what we do—which is just what AOD says. And we are in general less responsible for what we do under known-but-not-intended descriptions than for what we do under known-and-intended descriptions—which is just what PDE says. (shrink)

Judith Jarvis Thomson; Killing, Letting Die, and The Trolley Problem, The Monist, Volume 59, Issue 2, 1 April 1976, Pages 204–217, https://doi.org/10.5840/monis.

A number of common and generally noncontroversial practices in the care of patients at the end of life lead to their deaths. For example, physicians honor a patient's refusal of medical intervention even when doing so leads to the patient's death. Similarly, with a patient's or surrogate's consent, physicians administer sedatives in order to relieve pain and distress at the end of life, even when it is known that doing so will cause the patient's death. In contemporary U.S. public policy, (...) these practices are accepted as ethical and legal while physician-assisted suicide (PAS) isrejected in current U.S. law and public policy. Some think, however, that if one accepts practices that are known to lead to a patient's death, then one cannot reasonably reject a patient's request for a lethal dose of medication so that she may kill herself (PAS). (shrink)

According to the Principle of Double Effect (PDE), there are conditions under which it would be morally justifiable to cause some harm as a foreseen side-effect of one's action even though it would not be justifiable to form and execute the intention of causing the same harm. If we take the kind of justification in question to be that of moral permissibility, this principle correctly maps common intuitions about when it would be permissible to act in certain ways. T.M. Scanlon (...) argues that the PDE so interpreted is problematic, as it returns implausible verdicts in other scenarios. Scanlon is unable to account for the common pattern of moral reasoning that we employ in the relevant cases. I argue that we can account for this pattern while avoiding implausible verdicts if we interpret the PDE as a principle about when it is licit to inflict harm rather than when it is permissible to do so, and if we connect the concept of the licit with that of the permissible in the right way. (shrink)

Modern warfare cannot be conducted without civilians being killed. In order to reconcile this fact with the principle of discrimination in just war theory, the principle is applied through the doctrine of double effect. But this doctrine is morally inadequate because it is too permissive regarding the risk to civilians. For this reason, Michael Walzer has suggested that the doctrine be supplemented with what he calls the idea of double intention: combatants are not only to refrain from intending to harm (...) civilians; they are also to take precautions to reduce risk to civilians, even at the expense of increasing risk to themselves. The article develops the idea of double intention by addressing two questions: What does it mean to intend to reduce civilian risk, and how much should civilian risk be reduced? The results of this discussion are then used to consider a moral issue that arises in technologically asymmetric warfare, namely, the extent to which the use of precision-guided munitions, which allow more accurate targeting, can by itself bear the moral burden imposed by the principle of discrimination. (shrink)

Typically, in cases where an agent's actions produce foreseen harmful consequences, we morally discriminate in favor of scenarios in which those consequences are unintended. This intuitive distinction plays a particularly important role in our moral assessment of military strategies, especially when innocent bystanders may be involved. However, the analysis of the general principles governing such pre-theoretical inclinations must inevitably confront difficult and obstinate philosophical problems. As has often been pointed out, the criteria proposed by the traditional view on this issue, (...) the so-called Doctrine of Double Effect, are dependent upon the description of the agent's intentional profile in an intuitively inadmissible way. As a solution to the Doctrine's shortcomings, contemporary philosophers have proposed analyses in which the notion of harmful involvement plays a central role. The main thesis of this paper is that appeals to harmful involvement do not provide the desired solution. Given the pervasive role played by the assessment of an agent's intentions in our moral evaluation of the use of military force in particular situations, the philosophical puzzles raised in this paper bring to the foreground a set of correlated problems of unequivocal relevance for the discipline of military ethics. (shrink)

In this article the validity of transferring the Principle of Double Effect from the just war tradition to the domain of business is critically reviewed. If a case can be built for sufficient analogies between war and business, the principle of double effect can legitimately be transferred from war to business. If, on the other hand it can be shown that there are aspects in which business differs substantially from just war, then the transfer to business of a principle developed (...) within the context of war becomes more problematic. After exploring the nature of arguments of analogy and fallacious arguments of weak analogy some important disanalogies between war and business are highlighted. Given these disanalogies it is then contended that the just war background of the Principle of Double Effect had some bearing on both the content and manner of application of the Principle of Double Effect. Finally it is argued that these disanalogies require some revisions to the Principle of Double Effect with regard to both its content and its manner of application before it can be applied meaningfully to foreseeable negative side-effects of business. S. Afr. J. Philos. Vol.22(3) 2003: 236–246. (shrink)

The Doctrine of Double Effect has been defended not only as a test of character but also as a criterion of wrongness for action. This paper criticises one attempt to justify the doctrine in the latter capacity. The justification, first proposed by Warren Quinn, traces the wrongness of intending harm as a means to the objectionable features of certain reasons for making this our intention. As I argue, however, some of the actions which seem to us to be permissible, and (...) whose permissibility the DDE is supposed to explain, can be performed for these objectionable reasons. Since the proposed justification implies that any action is wrong when performed for these reasons, it renders the DDE incapable of accommodating the very intuitions about action which its proponents would have it explain. (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)

Self-driving cars hold out the promise of being safer than manually driven cars. Yet they cannot be a 100 % safe. Collisions are sometimes unavoidable. So self-driving cars need to be programmed for how they should respond to scenarios where collisions are highly likely or unavoidable. The accident-scenarios self-driving cars might face have recently been likened to the key examples and dilemmas associated with the trolley problem. In this article, we critically examine this tempting analogy. We identify three important ways (...) in which the ethics of accident-algorithms for self-driving cars and the philosophy of the trolley problem differ from each other. These concern: the basic decision-making situation faced by those who decide how self-driving cars should be programmed to deal with accidents; moral and legal responsibility; and decision-making in the face of risks and uncertainty. In discussing these three areas of disanalogy, we isolate and identify a number of basic issues and complexities that arise within the ethics of the programming of self-driving cars. (shrink)

In a familiar moral dilemma faced by physicians who care for the dying, some patients who are within days or hours of death may experience suffering in a degree that cannot be relieved by ordinary levels of analgesia. In such cases, it may sometimes be possible to honor a competent patient's request for pain relief only by giving an injection of narcotics in a dosage so large that the patient's death is thereby hastened. Doctors rightly worry that taking an action (...) likely to result in a patient's death may violate the Hippocratic injunction against the direct killing of anyone in their care. (shrink)

The doctrine of double effect, together with other moral principles that appeal to the intentions of moral agents, has come under attack from many directions in recent years, as have a variety of rationales that have been given in favor of it. In this paper, our aim is to develop, defend, and provide a new theoretical rationale for a secular version of the doctrine. Following Quinn (1989), we distinguish between Harmful Direct Agency and Harmful Indirect Agency. We propose the following (...) version of the doctrine: that in cases in which harm must come to some in order to achieve a good (and is the least costly of possible harms necessary), the agent foresees the harm, and all other things are equal, a stronger case is needed to justify Harmful Direct Agency than to justify Harmful Indirect Agency. We distinguish between two Kantian rationales that might be given for the doctrine, a “dependent right” rationale, defended by Quinn, and an “independent right” rationale, which we defend. We argue that the doctrine and the “independent right” rationale for it are not vulnerable to counterexamples or counterproposals, and conclude by drawing implications for the larger debate over whether agents' intentions are in any way relevant to permissibility and obligation. (shrink)

According to the classical Doctrine of Double Effect, there is a morally significant difference between intending harm and merely foreseeing harm. Versions of DDE have been defended in a variety of creative ways, but there is one difficulty, the so-called “closeness problem”, that continues to bedevil all of them. The problem is that an agent's intention can always be identified in such a fine-grained way as to eliminate an intention to harm from almost any situation, including those that have been (...) taken to be paradigmatic instances in which DDE applies to intended harm. In this paper, we consider and reject a number of recent attempts to solve the closeness problem. We argue that the failure of these proposals strongly suggests that the closeness problem is intractable, and that the distinction between intending harm and merely foreseeing harm is not morally significant. Further, we argue that there may be a deeper reason why such attempts must fail: the rationale that makes the best fit with DDE, namely, an imperative not to aim at evil, is itself irredeemably flawed. While we believe that these observations should lead us to abandon further attempts to solve the closeness problem for DDE, we also conclude by showing how a related principle that is supported by a distinct rationale and avoids facing the closeness problem altogether nevertheless shares with DDE its most important features, including an intuitive explanation of a number of cases and a commitment to the relevance of intentions. (shrink)