Doctrine of Double Effect

Ordinary people often make moral judgments that are consistent with philosophical principles and legal distinctions. For example, they judge killing as worse than letting die, and harm caused as a necessary means to a greater good as worse than harm caused as a side-effect . Are these patterns of judgment produced by mechanisms specific to the moral domain, or do they derive from other psychological domains? We show that the action ⁄ omission and means ⁄ side-effect distinctions affect nonmoral representations and provide evidence that their role in moral judgment is mediated by these nonmoral psychological representations. Specifically, the action ⁄ omission distinction affects moral judgment primarily via causal attribution, while the means ⁄ side-effect distinction affects moral judgment via intentional attribution. We suggest that many of the specific patterns evident in our moral judgments in fact derive from nonmoral psychological mechanisms, and especially from the processes of causal and intentional attribution.

Experimental research suggests that people draw a moral distinction between bad outcomes brought about as a means versus a side effect (or byproduct). Such findings have informed multiple psychological and philosophical debates about moral cognition, including its computational structure, its sensitivity to the famous Doctrine of Double Effect, its reliability, and its status as a universal and innate mental module akin to universal grammar. But some studies have failed to replicate the means/byproduct effect especially in the absence of other factors, such as personal contact. So we aimed to determine how robust the means/byproduct effect is by conducting a meta-analysis of both published and unpublished studies (k = 101; 24,058 participants). We found that while there is an overall small difference between moral judgments of means and byproducts (standardized mean difference = 0.87, 95% CI 0.67 – 1.06; standardized mean change = 0.57, 95% CI 0.44 – 0.69; log odds ratio = 1.59, 95% CI 1.15 – 2.02), the mean effect size is primarily moderated by whether the outcome is brought about by personal contact, which typically involves the use of personal force.

This paper analyses the concept of empirical ethics as well as three meta-ethical fallacies that empirical ethics is said to face: the is-ought problem, the naturalistic fallacy and violation of the fact-value distinction. Moreover, it answers the question of whether empirical ethics (necessarily) commits these three basic meta-ethical fallacies.

A traditional idea has it that moral judgment involves more than calculating the consequences of actions; it also requires an assessment of the agent’s intentions, the act’s nature, and whether the agent uses another person as a means to her ends. I survey experimental developments suggesting that ordinary people often tacitly reason in terms of such deontological rules. It’s now unclear whether we should posit a traditional form of the Doctrine of Double Effect. However, further research suggests that a range of non-consequentialist factors influence moral judgment, including: intentions, commissions, personal harm, and agent-centered commitments. Many, if not all, such factors appear to affect how involved the agent is in bringing about an outcome.

Recent developments in biogerontology—the study of the biology of ageing—suggest that it may eventually be possible to intervene in the human ageing process. This, in turn, offers the prospect of significantly postponing the onset of age-related diseases. The biogerontological project, however, has met with strong resistance, especially by deontologists. They consider the act of intervening in the ageing process impermissible on the grounds that it would (most probably) bring about an extended maximum lifespan—a state of affairs that they deem intrinsically bad. In a bid to convince their deontological opponents of the permissibility of this act, proponents of biogerontology invoke an argument which is grounded in the doctrine of double effect. Surprisingly, their argument, which we refer to as the ‘double effect argument’, has gone unnoticed. This article exposes and critically evaluates this ‘double effect argument’. To this end, we first review a series of excerpts from the ethical debate on biogerontology in order to substantiate the presence of double effect reasoning. Next, we attempt to determine the role that the ‘double effect argument’ is meant to fulfill within this debate. Finally, we assess whether the act of intervening in ageing actually can be justified using double effect reasoning.

Frequently, ethical dilemmas for clinicians in ICU focus on the conflict between the sanctity of life principle and other important ethical principles, such as patient autonomy or quality of life. Therefore, this chapter seeks to reveal the ethical tension between the sanctity of life and other competing ethical obligations, clearly outlining how the law in reality is making decisions and what a clinician's duties are in end of life issues.

Proponents of the linguistic analogy (Dwyer, 2009; Mikhail, 2011) suggest that methodologies originally developed for investigating linguistic grammar can also be fruitfully applied to the empirical study of moral grammar: the causal and intentional representations of moral events which – according to the linguistic analogy – drive moral judgments.  In the current study we put this claim to the empirical test. Participants were presented with moral dilemmas which previously have been shown to implement a central principle in moral judgments: the principle of double effect (PDE). Participants responded to by and in order to probes to assess causal and intentional representations of this principle. Results show that these linguistic probes do not relate to moral judgment in the manner predicted by proponents of the linguistic analogy and moral grammar. Although the linguistic analogy is a theoretically rich framework, the procedures posited to give it empirical traction require revision.

This paper discusses whether the collateral harm of imprisonment to the close family members and children of prison inmates may give rise to special moral obligations towards them. Several collateral harms, including decreased psychological wellbeing, financial costs, loss of economic opportunities, and intrusion and control over their private lives, are identified. Two competing perspectives in moral philosophy are then applied in order to assess whether the harms are permissible. The first is consequentialist and the second is deontological. It is argued that both of them fails and therefore it is hard to defend the position that allowing for these harms would be morally permissible, even for the sake of the overall aims of incarceration. Instead, it is argued that these harms imply that imprisonment should only be used as a last resort. Where it is necessary, it should give rise to special moral obligations. Using the notion of residual obligation, these obligations are defended, categorized and clarified.

This article focuses on the ethical implications of so-called ‘collateral damage’. It develops a moral typology of collateral harm to innocents which occurs as a side effect of military or quasi-military action. Distinguishing between accidental and incidental collateral damage, it introduces four categories of such damage: negligent, oblivious, knowing, and reckless collateral damage. Objecting mainstream versions of the doctrine of double effect, in the article it is argued that in order for any collateral damage to be morally permissible, violent agents must comply with high standards of care. In order for incidental harm to be permissible, an agent must take pains to avoid such harm even at higher cost to him. Adding to the doctrine, it is argued that accidentally, but negligently caused collateral damage may be just as difficult to excuse as incidental harm. Only if high precautionary standards of care are met, unintended harm to innocents – incidental or accidental – can be permissible. In practice, such a strong commitment to avoiding harm to civilians may well lead us to question more generally and rethink more radically how violent conflicts ought to be fought, how military violence ought to be used and whether there are better ways of achieving those aims that we think are legitimate than those we are currently taking.

"The “New Natural Law” Theory (NNL) of Germain Grisez, John Finnis, Joseph Boyle, and their collaborators offers a distinctive account of intentional action, which underlies a moral theory that aims to justify many aspects of traditional morality and Catholic doctrine.

In fact, we show that the NNL is committed to premises that entail the permissibility of many actions that are irreconcilable with traditional morality and Catholic doctrine, such as elective abortions. These consequences follow principally from two aspects of the NNL. The first aspect is its distinctive version of the planning theory of intention, in which adopting the 'first-person perspective' of an agent is a sufficient, and not merely necessary, condition for determining the nature of his intentional action; this planning theory rests upon an implicitly Cartesian conception of human behavior, in which behavior chosen by an agent has no intrinsic “intentionalness” apart from what he confers upon it as part of his plan. The second aspect is the NNL's distinctive account of basic human goods' incommensurability, according to which there is no common factor shared by basic human goods that allows them to be comparatively ranked in any way that directs practical deliberation.

The entailments of these two aspects of the NNL, we argue, amount to a reductio ad absurdum. Pace the proponents of the NNL account, we sketch an alternative hylomorphic conception of intentional action that avoids untoward moral implications by grounding human agency in the exercise of basic powers that are either (a) essential constituents of human nature or (b) acquired through participation in social practices. This conception of intentional action provides a stronger foundation for natural law theory."

For many years, moral philosophers have been debating the conceptual and moral status of the distinction between intending harm and (merely) foreseeing harm. In this paper, after surveying some of the objections to the moral significance of this distinction in general, I focus on the special case of state action, arguing that whatever reasons we have to be suspicious about the distinction's moral significance in general, we have very good reasons to believe it lacks intrinsic moral significance when applied to state action. After arguing for this claim, I pursue in a preliminary way some of its implications.

The article takes as its starting point the assumption that (a) competing accounts of moral rules should be judged by the distribution of benefits and burdens which would arise from everyone accepting these rules, and that (b) these benefits and burdens are understood in a way which has a substantial resource or freedom-based component. This starting point is compatible with  contractualism and various forms of rule consequentialism, and will yield a morality in which people have significant freedoms. The main claim of the article is that as a consequence of these freedoms, and because of phenomena connected with cost internalization, this morality will also impose strong constraints on harming and weak constraints on allowing harm. Thus the starting point ends up vindicating commonsense morality.

Professionals cure and comfort, and they do so in a trustworthy fashion. Pain specialists encounter some special issues as they seek to fulfill their professional mandate. Some key ethical issues that arise are described including situations involving end-of-life care needs, physician-assisted suicide requests, terminal sedation, doctrine of double effect, and chronic conditions. Policy issues are also described, including those related to controlled substances and access to pain treatment. This overview is an introductory presentation; it is supplemented by two cases, each with an analysis applying some of the ethical considerations described.

Judith Jarvis Thomson's Loop Case is particularly significant in normative ethics because it calls into question the validity of the intuitively plausible Doctrine of Double Effect, according to which there is a significant difference between harm that is intended and harm that is merely foreseen and not intended. Recently, Frances Kamm has argued that what she calls the Doctrine of Triple Effect (DTE), which draws a distinction between acting because-of and acting in-order-to, can account for our judgment about the Loop Case. In this paper, I first argue that even if the distinction drawn by DTE can be sustained, it does not seem to apply to the Loop Case. Moreover, I question whether this distinction has any normative significance. The upshot is that I am skeptical that DTE can explain our judgment about the Loop Case.

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 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.

Dr. Cohen practices internal medicine at a small community hospital in Nebraska. He recently admitted Mr. Lopez for rib and back pain, found, upon x-ray, to be due to pathological fractures. Mr. Lopez, 72, had a history of metastatic squamous cell lung cancer that had progressed despite two cycles of chemotherapy. Prior to admission, he had been on palliative chemotherapy and oxycodone, which provided imperfect relief of his day-to-day cancer-related pain.

The goal of this chapter is to examine the account of 'mixed' or 'necessitated' actions in NE 3.1, to see whether Aristotle's discussion there provides an analogue or anticipation of the so-called 'doctrine of double effect' (DE). This project will, I hope, prove illuminating as regards both mixed actions and DE.

In Intention and her subsequent essays that addressed human action, Elizabeth Anscombe made signal contributions to the Aristotelian-Thomistic tradition. The new natural law theory of Germain Grisez, John Finnis, Joseph Boyle, and their collaborators mistakenly claims to be consonant with Anscombe’s work. A central reason for this misappropriation lies in the failure to understand the ways in which Anscombe does and does not deploy a “first-person perspective” in analyzing intentional action. Far from supporting the new natural law, Anscombe’s work, rightly understood, provides arguments for rejecting it.

This paper argues for the permissibility of Physician-Assisted Suicide. First, based on the Thomson/Scanlon thesis on permissibility, it argues against the Doctrine of Double Effect. Second, it argues against the view held by Kant and David Velleman that because one has dignity it is impermissible to commit suicide under any circumstances. Third, it argues against both the theoretical and practical versions of the Slippery Slope Argument. Finally, it explains why the argument from abuse is not a good one. If contractualism is correct, the claims to PAS held by terminally ill patients who are in excruciating pain and want to die should override the claims of patients who would be pressurized into accepting PAS.

After the terrorist attacks of September 11, 2001, most legacy airlines filed for bankruptcy protection as a way to cut costs drastically, with the exception of American Airlines. This article applies the Principle of Double-Effect to the act of filing for Chapter 11 bankruptcy protection for reasons of management strategy, in particular, cost-cutting. It argues that the Principle can be a useful tool for discerning the ethicality of the action, and demonstrates the usefulness by proposing three double-effect criteria that, when fulfilled, argues for the ethical justifiability the action in question.

Double-Effect Reasoning (DER) implies the coexistence of good and evil in certain affairs; for a good outcome to appear, the possible evil side effects in its company or deviating from it are foreseen-but-not-intended. In Paradise Lost, God's creation serves His eternal plan, which is in essence good. The evil that follows, through Satan's rebellion, Adam and Eve's disobedience, ecological deterioration , and the Son of God's sacrifice, also happen under God's plan. These evil happenings, as paradoxes within good ends, follow the ethical principle of DER. Hence Milton's paradoxes in justifying God's ways in creation and His prelapsarian plan for the perfection of humankind through the Fall. The ambiguities of God's plan, in bringing good out of evil, can thus be explained through DER as an inevitable theological issue, which tries to explain the archetypal symbiosis between contradictions.

The Doctrine of Double Effect [DDE] states roughly that it is harder to justify causing or allowing harm as a means to an end than it is to justify conduct that results in harm as a side effect. This chapter argues that a theory of deontological constraints on harming needs something like the DDE in order to avoid the charge that it reflects a narcissistic obsession with the cleanliness of our own hands. Unfortunately, the DDE is often interpreted as maintaining that we must avoid acting with certain intentions, which, this chapter contends, embodies an equally narcissistic obsession with the purity of our own hearts. The chapter argues that the DDE is better interpreted as a denial of the Machiavellian idea that beneficial ends justify harmful means. On this view, the objective fact that our conduct will secure benefits for some individuals at the expense of other individuals weakens the extent to which those benefits count as reasons to engage in that conduct. The chapter argues that this version of the DDE provides a plausible, non-narcissistic foundation for deontological constraints.

Two hard cases have generated controversy regarding the application of the principle of double effect in recent years. As regards the first, the case of the conjoined twins of Malta, there has been considerable convergence: most natural law ethicists seem to agree that separation of the twins was morally permissible. By contrast, the so-called “Phoenix case,” involving an abortion at a Catholic hospital for a woman with pulmonary arterial hypertension, has become a touchstone of disagreement between defenders of the so-called “new” natural law theory, and more “traditional” Thomists. I argue in this essay that, contrary to widespread opinion, the two cases were alike in the following respect: in neither need the principal agents have intended the death of anyone.

Resumen: Este trabajo estudia la distinción entre "aborto directo" y "aborto indirecto". El propósito del autor es clarificar el sentido de esta distinción y mostrar que existen argumentos filosóficos sólidos para justificar su relevancia moral. Para lograr este objetivo expone, en primer lugar, el principal argumento esgrimido por quienes consideran el aborto (directo) como un acto intrínsecamente injusto; en segundo, muestra cuál es el origen histórico de la distinción entre aborto directo y aborto indirecto; en tercero, presenta un argumento para defender la relevancia moral de esta distinción y, finalmente, explica el modo en que ella opera, usando como ejemplo el análisis de T. L. Bouscaren sobre la salpingectomía de una trompa con feto ectópico.

Critical discussion of Thomson's and Scanlon's arguments against the view that the permissibility of an action may depend on the intention with which it is done. I argue that intentions can determine permissibility, but in a way that is different from  the principle of double effect.

Cooperation in wrongdoing is an everyday matter for all of us, though we need to discern when it is justified and when 'formal' cooperation is at stake, as opposed to 'material' (unintended) cooperation, whether justified or otherwise. In this paper, I offer some examples of material cooperation, and also formal cooperation where the cooperator intends a choice on the part of another which is wrong in itself, including wrongful preparation for some further wrongful act. I also offer examples of formal cooperation where the cooperator intends, not a choice wrong in itself on the part of another but a choice wrong in the circumstances, as thought by the other to cause serious, uncompensated harm to third parties.

Recently, Gerhard Øverland and Alec Walen have developed novel and interesting theories of nonconsequentialism. Unlike other nonconsequentialist theories such as the Doctrine of Double Effect (DDE), each of their theories denies that an agent's mental states are (fundamentally) relevant for determining how stringent their moral reasons are against harming others. Instead, Øverland and Walen seek to distinguish morally between instances of harming in terms of the circumstances of the people who will be harmed, rather than in features of the agent doing the harming. In this paper, we argue that these theories yield coun-terintuitive verdicts across a broad range of cases that other nonconsequentialist theories (including the DDE) handle with relative ease. We also argue that Wa-len's recent attempt to reformulate this type of theory so that it does not have such implications is unsuccessful.

‘We don’t torture’ announced both Bush and Obama. But what Bush meant as a statement of fact, Obama meant as a statement of resolve. Exploring this example, this article examines how moral resolutions work to overcome the rationalizations that temptation engenders. This in turn sheds light on the the nature of our moral concepts. Resolutions are typically framed using intentional notions (torture; murder; theft). Reflection on the reasons for this provides a new perspective on what is right, and what is wrong, about the doctrine of double effect.

Kai Draper works in the now dominant individualistic and reductive school of just war theory, according to which the moral justifiability of both going to war and killing in war is to be understood along the same lines as acts of self- and other- defense between individuals. But Draper challenges a central pillar of the moral view embraced by, as far as I know, all the other writers in the same school of just war theory. He argues that what he calls the “principle of double effect” (PDE) and related doctrines—including my own “restricting claims principle”—are false. In their stead, he develops a small set of rights-based principles that he thinks distinguish permissible from impermissible acts of killing in war.

Draper writes with an admirable combination of wisdom, humility, originality, and clarity. The result is an important contribution to just war theory. Nonetheless, I argue that his challenge to the PDE and related doctrines fails, and that the distinctive prescriptions the book offers must also, therefore, be rejected.

Several critiques of the New Natural Law theory of action are to be found in a special issue of the National Catholic Bioethics Quarterly dedicated to criticizing the NNL theory as a whole.  This essay addresses three of the articles in that issue. Those essays, by Steven A. Long, Matthew O’Brien, and Fr. Kevin Flannery, SJ, as well as a more recent essay by Edward Furton (in Ethics and Medics), eventually converge on a variation of the “closeness” criticism that I will address in the second part of the paper.  In the first part, I address three further issues, raised, respectively, by Flannery, Long, and O’Brien.