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)

T. A. Cavanaugh's Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession's unique internal medical ethic - in its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical ethic arose from reflection on the most vexing medical-ethical problem -- injury caused by a physician -- and argues (...) that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession. The book argues that medicine as a profession necessarily involves stating before others what one stands for: the good one seeks and the bad one seeks to avoid on behalf of the sick, and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes noting that medical promising (as found in the White Coat Ceremony through which U. S. medical students matriculate) implicates medical autonomy which in turn merits respect, including honoring professional conscientious objections. (shrink)

Double-effect reasoning (DER) is attributed to Aquinas "tout court". Aquinas's account, however, differs from contemporary DER insofar as Thomas considers the ethical status of "risking" an assailant's life while contemporary accounts focus on actions causing harm inevitably. Since one cannot claim to risk the inevitable, and since there is a significant difference between risking harm and causing harm inevitably. Thomas's account does not extend to cases of inevitable harm. Thus, the received understanding of Aquinas's account is flawed and leads to (...) untenable attributions of the direction of intention to Aquinas and to misunderstandings of contemporary DER. (shrink)

This article articulates the Hippocratic medical ethic found in the Oath and the Christian medical ethic as exemplified in the parable of the Good Samaritan. It proposes that the Oath has a natural-law-based deontological character (as understood by Aquinas) that governs friendships of utility (as understood by Aristotle) between student and teacher and physician and patient. The article elaborates on the Samaritan’s conduct as exemplifying Christian agapeic-love. It contrasts agapeic-love with friendship-love, while noting that the Samaritan relies on friendship-love (as (...) found between the Samaritan and the innkeeper) to realize agapeic-love towards the robbers’ victim. It concludes with noting that the grace-based Christian medical ethic perfects the nature-based Hippocratic ethic not by destroying it, but, rather, by employing it. (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)

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)

This paper argues that the current stock of anti-personnel cluster bombs are temporally indiscriminate, and, therefore, unjust weapons. The paper introduces and explains the idea of temporal indiscriminateness. It argues that to honor non-combatant immunity—in addition to not targeting civilians—one must adequately target combatants. Due to their high dud rate, cluster submunitions fail to target combatants with sufficient temporal accuracy, and, thereby, result in avoidable serious harm to non-combatants. The paper concludes that non-combatant immunity and the principle of discrimination require (...) a moratorium on the use of current cluster munitions. (shrink)

In “Modern Moral Philosophy” Anscombe argues that the distinction between intention of an end or means and foresight of a consequentially comparable outcome proves crucial in act-evaluation. The deontologist J. J. Thomson disagrees. She asserts that Anscombe mistakes the distinction’s moral import; it bears on agent-evaluation, not act-evaluation. I map out the contours of this dispute. I show that it implicates other disagreements, some to be expected and others not to be expected. Amongst the expected, one finds the ethicists’ accounts (...) of action and understanding of how agent-assessment relates to act-assessment. Amongst the unexpected, one finds the moralists’ views about the possibility of self-imposed moral dilemmas and allied positions concerning temporal aspects of “ought implies can.” Anscombe’s employment of the distinction in act-evaluation withstands close scrutiny; Thomson’s denial of it does not. (shrink)

In “Modern Moral Philosophy” Anscombe argues that the distinction between intention of an end or means and foresight of a consequentially comparable outcome proves crucial in act-evaluation. The deontologist J. J. Thomson disagrees. She asserts that Anscombe mistakes the distinction’s moral import; it bears on agent-evaluation, not act-evaluation. I map out the contours of this dispute. I show that it implicates other disagreements, some to be expected and others not to be expected. Amongst the expected, one finds the ethicists’ accounts (...) of action and understanding of how agent-assessment relates to act-assessment. Amongst the unexpected, one finds the moralists’ views about the possibility of self-imposed moral dilemmas and allied positions concerning temporal aspects of “ought implies can.” Anscombe’s employment of the distinction in act-evaluation withstands close scrutiny; Thomson’s denial of it does not. (shrink)

In this essay I articulate Aristotle’s account of the voluntary with a view to weighing in on a contemporary ethical debate concerning the moral relevance of the intended / foreseen distinction. Natural lawyers employ this distinction to contrast consequentially comparable acts with different intentional structures. They propose, for example, that consequentially comparable acts of terror and tactical bombing morally differ, based on their diverse structures of intention. Opponents of double-effect reasoning hold that one best captures the widely acknowledged intuitive appeal (...) of the distinction by contrasting agents, not acts. These thinkers hold that the terror bomber differs from the tactical bomber while terror bombing does not differ ethically from tactical bombing. Aristotle’s accounts of the voluntary and the deliberately decided upon provide grounds for the ethical relevance of the intended / foreseen distinction as applied to both acts and agents. (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)

Common morality endorses some form of an exceptionless prohibition against killing innocents. Natural lawyers employ double-effect reasoning to address hard cases involving deaths of the innocent. Current deontologists criticize DER-proponents as conflating act-with agent-evaluations. Scanlon develops this critique extensively. I respond to his criticism. He maintains that the DER-advocate tells a badly-motivated agent to refrain from an obligatory act. Thus, he asserts, the natural lawyer who employs DER errs. Instead, Scanlon proposes, one ought to assess the act as permissible while (...) blaming the agent. I argue that DER does not succumb to this critique. Moreover, Scanlon’s particular criticism nicely shows the reasonableness of the approach the DER-thinker takes, namely, that defective agents produce defective acts. Thus, employing DER does not lead to a confusion of act-with agent-evaluations. Rather, it results in coherent assessments of both. (shrink)

Common morality endorses some form of an exceptionless prohibition against killing innocents. Natural lawyers employ double-effect reasoning to address hard cases involving deaths of the innocent. Current deontologists criticize DER-proponents as conflating act-with agent-evaluations. Scanlon develops this critique extensively. I respond to his criticism. He maintains that the DER-advocate tells a badly-motivated agent to refrain from an obligatory act. Thus, he asserts, the natural lawyer who employs DER errs. Instead, Scanlon proposes, one ought to assess the act as permissible while (...) blaming the agent. I argue that DER does not succumb to this critique. Moreover, Scanlon’s particular criticism nicely shows the reasonableness of the approach the DER-thinker takes, namely, that defective agents produce defective acts. Thus, employing DER does not lead to a confusion of act-with agent-evaluations. Rather, it results in coherent assessments of both. (shrink)

If viable, DER justifies certain individual acts that—by definition—have two effects. Presumably, it would in some fashion justify policies concerning the very same acts. By contrast, acts that sometimes have a good effect and sometimes have a bad effect do not have the requisite two effects such that DER can justify them immediately. Yet, a policy concerning numerous such acts would have the requisite good and bad effects. For while any one such act would lack the relevant two effects, a (...) series of such acts and a policy governing such a series would have them. This paper addresses DER’s justification of policies that apply to such acts. It shows that there are certain acts which DER mediately justifies by justifying policies concerning them. Thus, it recommends the larger topic of DER’s bearing on policy. (shrink)

By analogy to justifications offered for craniotomy by Catholic moralists (e.g., Germain Grisez and Rev. Martin Rhonheimer), a recent instance of casuistry (by the moral theologian M. Therese Lysaught) attempts to apply double-effect reasoning and, separately, the concept of a vital conflict to justify dilation and curettage in order to preserve the life of a pregnant woman. This paper examines and rejects these bases for justifying craniotomy and D&C. It concludes with a consideration of Pope John Paul II’s discussion of (...) moral martyrdom in Veritatis splendor. National Catholic Bioethics Quarterly 11.3 (Autumn 2011): 453–463. (shrink)

Common morality endorses some form of an exceptionless prohibition against killing innocents. Natural lawyers employ double-effect reasoning to address hard cases involving deaths of the innocent. Current deontologists criticize DER-proponents as conflating act-with agent-evaluations. Scanlon develops this critique extensively. I respond to his criticism. He maintains that the DER-advocate tells a badly-motivated agent to refrain from an obligatory act. Thus, he asserts, the natural lawyer who employs DER errs. Instead, Scanlon proposes, one ought to assess the act as permissible while (...) blaming the agent. I argue that DER does not succumb to this critique. Moreover, Scanlon’s particular criticism nicely shows the reasonableness of the approach the DER-thinker takes, namely, that defective agents produce defective acts. Thus, employing DER does not lead to a confusion of act-with agent-evaluations. Rather, it results in coherent assessments of both. (shrink)

This paper concerns the deficiencies of currentlyaccepted principles governing the fair use ofelectronically recorded data when applied to geneticinformation. Principles are proposed by which to dealwith the unique group-characteristics of geneticinformation.

This is a condensed description of the contents and overarching argument found in Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. In that work, I maintain that the basic medical ethical problem concerns iatrogenic harm. I focus particularly on what I refer to as ‘role-conflation’. This most egregious form of iatrogenic harm occurs when a physician deliberately adopts the role of wounder. A contemporary practice such as physician-assisted suicide exemplifies a doctor’s deliberate wounding. I argue that the (...) author of the Hippocratic Oath – aware of the chronic risk of role-conflation – responds to this threat by having the oath-taker specifically forswear signal acts that wound the sick, such as giving a deadly drug even if asked, giving an abortifacient, sexual predation, and gossiping. I argue that by means of the Oath, Hippocrates founds medicine as a profession, a practice intimately involving promising. (shrink)

Among the oldest extant medical ethics, the Hippocratic Oath prohibits the giving of a deadly drug, regarding this act as an egregious violation of a medical ethic that is exclusively therapeutic. Proportionate palliative sedation involves the administration of a deadly drug. Hence it seems to violate the venerable Hippocratic promise associated with the dawn of Western medicine not to give a deadly drug. Relying on distinctions commonly employed in the analysis and evaluation of human actions, this article distinguishes physician-assisted suicide (...) and euthanasia, as acts that necessarily violate the prohibition against giving a deadly drug, from proportionate palliative sedation, as an act that does not. (shrink)

In what follows, I reply to critical appraisals of my book entitled Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. Professors Tollefsen, McPherson, and Potts separately offer these thoughtful critiques. Professor Tollefsen approaches the work from the standpoint of the physician-patient relationship. Professors McPherson and Potts both address it in terms of virtues. Potts treats the theme of virtue generally while McPherson focuses on the virtue of piety. Since virtues attend relationships, in what follows, I discuss, first, (...) the physician-patient relationship ; second, virtue generally ; and third, and finally, the virtue of piety specifically. (shrink)

In contemporary ethical discourse generally, and in discussions concerning the legalization of physician‐assisted suicide (PAS) and voluntary active euthanasia (VAE) specifically, recourse is sometimes had to the Nazi! accusation. Some disputants charge that such practices are or will become equivalent to the Nazi ‘euthanasia’ program in which over 73,000 handicapped children and adults were killed without consent. This paper reflects on the circumstances that lead to the use of this charge and offers reasons for putting the Nazi! charge aside in (...) contemporary discussions of PAS and VAE. A number of the philosophical presuppositions common to both the Nazi ‘euthanasia’ program and the currently proposed practices of PAS and VAE are examined. Noting that racist ideology and violent coercion characterized the Nazi program, the paper concludes with a cautionary consideration of the current circumstances that would specify PAS and VAE in the US. (shrink)

Itself a topic of constant comment, the Internet's implications for healthcare remain unclear even while its boundaries incessantly expand. The WorldWide Web and allied technologies such as telephony are clearly permanent fixtures of our world. These technologies have changed our ways of life and demonstrate further dynamic capacities to do so. They speak of what we shall be, but know not.

Proponents commonly justify the legalization of physician-assisted suicide (PAS) in terms of a patient's wanting to die (autonomy) and the patient's having a medically established good reason for suicide. These are the common elements of the standard justification offered for the legalization of PAS. In what follows, I argue that these two conditions exist in significant tension with one another, operating according to distinct dynamics that render the justification for PAS an unstable basis for public policy. Moreover, no natural connection (...) keeps these two criteria united. Indeedthe two elements of the justification oppose and threaten to exclude one another. Thus, the PAS justification is too labile a basis for sound public policy. (shrink)

Suzanne Uniacke has written an adventurous and philosophically elegant work in which she justifies the intentional use of necessary and proportionate lethal force in private homicidal self-defense. Her contribution will interest those engaged in discussions concerning the ethics of homicide.