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 practice whereby terminally ill patients choose to end their own lives painlessly by ingesting a drug prescribed by a physician has commonly been referred to as physician-assisted suicide. There is, however, a strong trend forming that seeks to deny that this act should properly be termed suicide. The purpose of this paper is to examine and reject the view that the term suicide should be abandoned in reference to what has been called physician-assisted suicide. I argue that there are (...) no good conceptual or philosophical reasons to avoid the suicide label. I contend that intending one’s death is essential to the nature of suicide, and this intention is normally required on the part of the terminally ill patient when she knowingly takes a life-ending drug. Additionally, the analysis shows that any plausible strategy that avoids the term suicide is counteracted by the way in which advocates of the practice want to make it legal. (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)

Various theories of moral cognition posit that moral intuitions can be understood as the output of a computational process performed over structured mental representations of human action. We propose that action plan diagrams—“act trees”—can be a useful tool for theorists to succinctly and clearly present their hypotheses about the information contained in these representations. We then develop a methodology for using a series of linguistic probes to test the theories embodied in the act trees. In Study 1, we validate the (...) method by testing a specific hypothesis (diagrammed by act trees) about how subjects are representing two classic moral dilemmas and finding that the data support the hypothesis. In Studies 2–4, we explore possible explanations for discrete and surprising findings that our hypothesis did not predict. In Study 5, we apply the method to a less well‐studied case and show how new experiments generated by our method can be used to settle debates about how actions are mentally represented. In Study 6, we argue that our method captures the mental representation of human action better than an alternative approach. A brief conclusion suggests that act trees can be profitably used in various fields interested in complex representations of human action, including law, philosophy, psychology, linguistics, neuroscience, computer science, robotics, and artificial intelligence. (shrink)

A person drives her well‐maintained car cautiously and alertly to the movies. Freak circumstances send the car out of control. It veers in the direction of a pedestrian whom it will kill unless she, or a third party, blows it up with a grenade. Whether the driver is liable to be thusly killed polarizes debates about the ethics of self‐defense. But debaters frequently conflate the questions of whether and by what means the driver is liable to be killed. The paper (...) separates these questions: it argues the driver's liability to lethal harm need not entail her liability to the grenade. (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)

It has long been thought that by using morphine to alleviate the pain of a dying patient, a doctor runs the risk of causing his death. In all countries this kind of killing is explicitly or silently permitted by the law. That permission is usually explained by appealing to the doctrine of double effect: If the use of morphine shortens life, that is only an unintended side effect. The paper evaluates this view, finding it flawed beyond repair and proposing an (...) alternative explanation. It is not the intention of the doctor that counts, but the availability of an “objective” palliative justification. (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)

This paper develops a question-sensitive theory of intention. We show that this theory explains some puzzling closure properties of intention. In particular, it can be used to explain why one is rationally required to intend the means to one’s ends, even though one is not rationally required to intend all the foreseen consequences of one’s intended actions. It also explains why rational intention is not always closed under logical implication, and why one can only intend outcomes that one believes to (...) be under one’s control. (shrink)

There is both individual and collective widespread concern in society about the impact of human activity and the effects of our decisions on the physical and social environment. This concern is included within the idea of sustainability. The meaning of the concept is still ambiguous and its practical effectiveness disputed. Like many other authors, this article uses as a starting point the definition proposed by the World Commission on Environment and Development, considering it to be a proposal for changing the (...) assessment of the effects of decisions, from at least two perspectives: what effects we should consider and how we should assess them. Based on this double perspective, sustainability is explored as a method for decision-making which both expands the assessment of the consequences, and also provides an objective criterion for such assessment. It will be argued that the idea of sustainability, seen from this perspective, brings to decision-making two qualities which had been partially lost: realism and impartiality. In turn, the criteria for realism and impartiality in decision-making can be used to identify the limitations of some partial approaches to sustainability, which suffer from insufficient realism, insufficient impartiality or both phenomena at once. The article concludes by demonstrating how realism and impartiality provide the basis for a new form of sustainable decision-making, which is dependent on the development of two moral virtues, prudence and benevolence, and which brings practical effectiveness and ethical sense to the concept of sustainability. (shrink)

Trolley dilemmas have been used to justify the intuitive appeal of the doctrine of double effect. According to this doctrine, if a good action has a harmful side effect, it is morally acceptable to do it, provided the harmful effect is not intended. However, in some variants of the dilemma, most people are willing to forego this doctrine, thus making responses inconsistent. In this study, 404 university students from the United Arab Emirates (UAE) were presented with 4 versions of the (...) trolley dilemma. Results came out showing that higher levels of depressive symptoms predict greater consistency in adherence (or rejection) to the doctrine of double effect. Likewise, higher levels of depressive symptom predict utilitarian responses to trolley dilemmas. Anxiety symptoms had similar effects, but more moderate. Demographic variables (age, gender) were also assessed as predictors of responses and consistency to trolley scenarios, but no significant effects were found. (shrink)