The breadth of themes addressed in this issue of the Journal of Medicine and Philosophy is striking. These articles brim with some of the most foundational questions one can ask in bioethics and the philosophy of medicine: Under what circumstances might we risk some harm in pursuit of a greater good? In the setting of experimental therapies, how should we weigh the potential risk and benefit for an individual patient against the broader potential benefit realized for society as a whole? (...) How might we consistently differentiate health from pathology? Under what circumstances might we say that a human being has died? Does acknowledging particular things as good generate duties? Duties for whom and enforced by whom? These articles share a preoccupation with foundational questions that must be addressed in any sound bioethics curriculum, and they make clear that our answers to these questions are not simply theoretical but manifest in policy and in practice. (shrink)

A recent administrative law decision in Victoria, Australia, applied double effect reasoning in a novel way. Double effect reasoning has hitherto been used to legitimate treatments which may shorten life but where the intent of treatment is pain relief. The situation reviewed by the Victorian tribunal went further, supporting actions where a doctor agrees to provide pentobarbitone to a patient at some time in the future if the patient feels at that time that his pain is unbearable and he wants (...) to end his life. The offer to provide the drug was described as a palliative treatment in that it gave reassurance and comfort to the patient. Double effect reasoning was extended in this instance to encompass potentially facilitating a patient’s death. This extension further muddies the murky double effect reasoning waters and creates another challenge to this concept. (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)