A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: double-effect sedation, parsimonious direct sedation, and sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices (...) are defined clearly and evaluated ethically. It is concluded that, if one is opposed to euthanasia and assisted suicide, double-effect sedation can frequently be ethically justified, that parsimonious direct sedation can be ethically justified only in extremely rare circumstances in which symptoms have already completely consumed the patient’s consciousness, and that sedation to unconsciousness and death is never justifiable. The special case of sedation for existential suffering is also considered and rejected. (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)

Solar radiation management (SRM), a form of climate engineering, would offset the effects of increased greenhouse gas concentrations by reducing the amount of sunlight absorbed by the Earth. To encourage support for SRM research, advocates argue that SRM may someday be needed to reduce the risks from climate change. This paper examines the implications of two moral constraints—the Doctrine of Doing and Allowing, and the Doctrine of Double Effect—on this argument for SRM and SRM research. The Doctrine of Doing and (...) Allowing, and perhaps the Doctrine of Double Effect, shows that the argument is weaker than it appears. (shrink)

In this reply, I seek to summarize fairly the criticisms advanced by each of my four critics, Jonathan Schaffer, Gideon Yaffe, John Gardner, and Carolina Sartorio. That there is so little overlap either in the aspects of the book on which they focus or in the arguments they advance about those issues has forced me to reply to each of them separately. Schaffer focuses much of his criticisms on my view that absences cannot serve as causal relata and argues that (...) this commits me to the view that double preventions cannot be causal of events such as deaths. I deny that double preventions such as beheadings are not causal, while admitting that other double preventions are not causal but denying that this latter conclusion is unwelcome in its implications. Yaffe criticizes my view that a person substantially causing some harm H is sufficient for that person having performed the activity of H-ing, whereas I affirm that causing H is sufficient for doing the action of H-ing even if it is not sufficient for intentionally H-ing. Gardner takes issue with my “experiential argument” for the relevance of causation to moral blame; he urges that we cannot infer that we are more guilty from either the psychological fact that we feel more guilty or from the moral fact that it is virtuous to feel such heightened guilt, because it is viciously circular: we feel such guilt only because we have already judged that we are more guilty, and it is virtuous to feel such guilt only because we in fact are more guilty. I deny such circularity exists. Sartorio takes issue with my thesis that in omissive overdetermination cases neither omitter is morally responsible for the harm. I trade intuitions with Sartorio about a range of related cases that we each think bears on the issue. (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)

A major challenge to the Doctrine of Double Effect is the concern that an agent’s intention can be identified in such a fine-grained way as to eliminate an intention to harm from a putative example of an intended harm, and yet, the resulting case appears to be a case of impermissibility. This is the so-called “closeness problem.” Many people believe that one can address the closeness problem by adopting Warren Quinn’s version of the DDE, call it DDE*, which distinguishes between (...) harmful direct agency and harmful indirect agency. In this paper, I first argue that Quinn’s DDE* is just as vulnerable to the closeness problem as the DDE is. Second, some might think that what we should therefore do is give up on intentions altogether and move towards some kind of non-state-of-mind, victim-based deontology. I shall argue against this move and explain why intentions are indispensable to an adequate nonconsequentialist theory. Finally, I shall propose a new way of answering the closeness problem. (shrink)

The Doctrine of Double Effect (DDE) is an influential non-consequentialist principle positing a role for intention in affecting the moral permissibility of some actions. In particular, the DDE focuses on the intend/foresee distinction, the core claim being that it is sometimes permissible to bring about as a foreseen but unintended side-effect of one’s action some harm it would have been impermissible to aim at as a means or as an end, all else being equal. This article explores the meaning and (...) application of the DDE along with current debates over the nature of the intend/foresee distinction and its moral significance. How is the line between intended effects and merely foreseen but unintended side-effects to be drawn, and how are problem cases best handled? What is an appropriate methodology for debating the tenability of the DDE? How might the DDE interact with other non-consequentialist principles, and how might it be modified to capture other related factors (resulting perhaps in a Doctrine of Triple Effect) or to avoid certain problem cases? Does the DDE make permissibility turn on the actual intentions of particular agents, as critics such as Thomson and Scanlon assume, or is the role of intention more abstract? (shrink)

Based on the results of empirical studies of folk moral judgment, several researchers have claimed that something like the famous Doctrine of Double Effect may be a fundamental, albeit unconscious, component of human moral psychology. Proponents of this psychological DDE hypothesis have, however, said surprisingly little about how the distinction at the heart of standard formulations of the principle—the distinction between intended and merely foreseen consequences—might be cognised when we make moral judgments about people’s actions. I first highlight the problem (...) of precisely formulating the distinction between intended and foreseen consequences and its implications for interpreting the empirical data on folk moral judgment. I then distinguish between three different approaches to this problem that have been taken by proponents of the DDE in normative ethics: so-called “closeness” accounts, accounts that employ what has come to be known as a “strict” notion of intention, and Warren Quinn’s recasting of the DDE in terms of the distinction between “direct” and “indirect agency”. I show that when taken as claims about moral psychology, these different accounts entail quite different empirical predictions about what people’s moral judgments should be in particular cases. Based on the current empirical data, I argue that a version of Quinn’s formulation of the DDE is the most empirically plausible, and that adopting such a formulation helps to diffuse much of the recent empirical criticism of the DDE hypothesis. (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)

The problem of closeness was posed by Philippa Foot in the article “The Problem of Abortion and the Doctrine of Double Effect”. Foot criticizes the classic version of the principle of double effect which distinguishes direct from indirect intention. On this basis, she considers it justified to cause bad effects which were foreseen but not intended. She believes that if we consider causing a bad effect to be justified then the way we do it is irrelevant, while the reference to (...) the direct/indirect distinction may lead to absurd solutions in some cases that allow us to distinguish two events in one action. These constitute, respectively, the object of direct and indirect intention and they are much too close for an application of the principle of double effect, such as when a doctor performs a craniotomy. The root of the problem of closeness is the question about the possible criterion that would allow us to determine which of the effects of an action are intended and which are merely foreseen. The starting point of the analysis of the problem of closeness in this article is the manner in which Foot outlines it in her article. In the second and more extensive part of the article, a number of contemporary attempts to solve the problem of closeness are presented, while the third section is an attempt to answer the question of why the discussion of the problem of closeness seems to remain deadlocked. (shrink)

The Doctrine of Double Effect (DDE) provides that, all else equal, intentional deaths are harder to justify than merely foreseen deaths. The principle is meant to ground the distinction within humanitarian law between terror bombing and strategic bombing. However, according to the “closeness problem,” terror bombers are not necessarily intentional killers. Terror bombing strictly requires only that the civilians appear dead, goes the argument, such that—for a “sophisticated” terror bomber—the civilians’ deaths could be unintended side-effects of making them appear dead. (...) But if intentions could be calibrated so finely and strategically, the argument continues, then the DDE would very doubtfully be true. This essay replies to the closeness problem in three steps. First, agents often intend _causal processes_, with specific causal “ingredients,” as the proximate means of bringing about their specifically intended means or ends. Second, when an agent foresees a byproduct as resulting directly from their intended causal process, it is morally equivalent to a specifically intended outcome. The process’s causal relationship to the byproduct is constitutive of the process from the agent’s perspective. Third, a “sophisticated” terror bomber’s intended causal process involves blowing up the civilians, while a strategic bomber’s involves blowing up, say, a munitions factory. Thus, because the “sophisticated” terror bomber foresees their intended causal process as resulting directly in the civilians’ deaths, while the strategic bomber foresees their deaths as side-effects of their intended causal process occurring within an environment that happens to contain civilians, the DDE can distinguish between the bombers. (shrink)

Civilian Immunity is the legal and moral protection that civilians enjoy against the effects of hostilities under the laws of armed conflict and according to the ethics of killing in war. Immunity specifies different permissibility conditions for directly targeting civilians on the one hand, and for harming civilians incidentally on the other hand. Immunity is standardly defended by appeal to the Doctrine of Double Effect. We show that Immunity's prohibitive stance towards targeting civilians directly, and its more permissive stance towards (...) harming them incidentally, can be defended without appealing to the DDE if agents suffer from overconfidence. Overconfidence is a cognitive bias that affects agents who are required to make decisions in the presence of significant uncertainty. (shrink)

Terminally ill people might want to discuss the options they have of hastening their deaths with their psychologists who should therefore know the law that regulates euthanasia in the jurisdictions where they practice. The legal, and therefore ethical, situation that influences psychologists’ position and terminally ill people’s options, however, differs notably across jurisdictions. Our aim is to provide a brief moral-legal historical context that explains how the law reform processes in different jurisdictions created these different legal contexts and options that, (...) in turn, influence psychologists’ ethical position. We conclude by considering 8 specific ethical issues at a conceptual level that might confront psychologists irrespective of where they practice. (shrink)