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At a time when death-and-dying are increasingly thought of as medical events, even to the point where professionals traditionally oriented towards healing are sometimes thought to be responsible for intentionally ending the lives of patients, it is becoming increasingly clear that palliative care is both unique and critically important. In this paper I show the need for clear articulation of the philosophy of this distinctive practice that properly acts with intent towards neither health in a narrowly medical sense nor patient death. I propose four lenses through which a rigorous philosophy of palliative care may be approached: trust, intent, authenticity, and the foundational question of good dying - literally euthanasia. I contend that proper palliative care seeks to cloak ( palliare) pain within the context of trusting relationships both as a good in itself and as way of de-cloaking the things that form important components of most people's narratives of good dying: opportunities to authentically engage with trusted others with the aim of finding some kind of meaning in life and community, even during the process of dying. Furthermore, palliative care is characterized by a non-paternalistic willingness to point outside of itself in order to help patients authentically engage the important existential questions of human mortality via lenses that extend beyond those offered by scientific medicine. [ABSTRACT FROM AUTHOR]

Many philosophers display relaxed scepticism about the Doctrine of Doing and Allowing (DDA) and the Doctrine of Double Effect (DDE), suspecting, without great alarm, that one or both of these Doctrines is indefensible. This relaxed scepticism is misplaced. Anyone who aims to endorse a theory of right action with Nonconsequentialist implications (henceforth any Nonconsequentialist) should accept both the DDA (or a replacement) and the DDE (or a replacement). First, even to state a Nonconsequentialist theory requires drawing a distinction between respecting and promoting values. This cannot be done without accepting some deontological distinction. Second, if someone is going to accept any deontological distinction she should accept either the DDE or the DDA or some replacement. Finally, anyone who accepts either the DDE or the DDA should accept both doctrines or a replacement of each. Unless both Doctrines can be defended or given a defensible replacement, any Nonconsequentialist is in trouble. [ABSTRACT FROM PUBLISHER]

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Combined oral contraceptives (COC) have been demonstrated to have significant benefits for the treatment and prevention of disease. These medications also are associated with untoward health effects, and they may be directly contraceptive. Prescribers and users must compare and weigh the intended beneficial health effects against foreseeable but unintended possible adverse effects in their decisions to prescribe and use. Additionally, those who intend to abide by Catholic teachings must consider prohibitions against contraception. Ethical judgments concerning both health benefits and contraception are approached in this essay through an overview of the therapeutic, prophylactic, untoward, and contraceptive effects of COC and discussion of magisterial and traditional Catholic teachings from natural law. Discerning through the principle of double effect, proportionate reason, and evidence gathered from the sciences, medical and moral conclusions are drawn that we believe to be fully compliant with good medicine and Catholic teaching. [ABSTRACT FROM AUTHOR]

Judith Jarvis Thomson has recently proposed a new argument for the thesis that killing the one in the Trolley Problem is not permissible. Her argument relies on the introduction of a new scenario, in which the bystander may also sacrifice herself to save the five. Thomson argues that those not willing to sacrifice themselves if they could may not kill the one to save the five. Bryce Huebner and Marc Hauser have recently put Thomson's argument to empirical test by asking people what they should do in the new trilemma case, in which they may also sacrifice themselves. They found that the majority judge that they should either kill the one or sacrifice themselves; Huebner and Hauser argue that those numbers speak against Thomson's argument. But Thomson's argument was about the dialectical effect of the new trilemma on the traditional dilemma, rather than about the trilemma itself. Here I present the results of a study in which I asked subjects first what they should do in the trilemma and then what they should do in the traditional Trolley Problem. I found that, if asked first about the trilemma, subjects then have the intuition that killing the one in the traditional Bystander at the Switch is not permissible—exactly what Thomson's argument had predicted. [ABSTRACT FROM PUBLISHER]

I argue for the following, which I dub the "fallibility syllogism": (1) All systems of criminal punishment that inflict suffering on the innocent are unjust from a desert-based, retributivist point of view. (2) All past or present human systems of criminal punishment inflict suffering on the innocent. (3) Therefore, all such human systems of criminal punishment are unjust from a desert-based, retributivist point of view. My argument for the first premise is organized in the following way. I define what a human system of punishment is. I offer a distinction between retributive and utilitarian approaches to punishment. I distinguish between weak retributivism embodied in the second premise and strong retributivism, which I argue is the basis for the weak version. I argue that on retributivist grounds, each case of punishment is just when it matches the seriousness of the wrongdoing of the offender and that systems of punishment are just from a retributivist point of view when there are no exceptions to this match-up. In making my case, I will use Kant's retributivism as the version of my choice, so I will spend some time showing that recent reinterpretations of Kant (arguing that he was not a thoroughgoing retributivist), even if they are correct, are consistent with my view. Ultimately, however, I argue that the better view is that Kant was a thoroughgoing retributivist. [ABSTRACT FROM AUTHOR]

Right intention is one of the staple criteria of traditional just war theory. In classical terms, right intention is met when a belligerent aims to achieve a just and peaceful order. I will address the problem of determining when a belligerent has satisfied the criterion of right intention. I will argue that right intention is determined by observing a belligerent's acts during and after a conflict. Intention is not merely a private mental act known ultimately only by the people who express the intentions of their governments. Rather, right intention is a communal, public act, for the observable circumstances are how intention is determined. I will demonstrate the effectiveness of this way of determining intention by concentrating on the stated intentions of the Allies before World War II and of the U.S. before the First and Second Gulf Wars. The goal of the paper is to demonstrate that the international community can check a belligerent's stated intentions both while the war is in progress and after the war has ended. I will argue that how well a belligerent conforms to the jus in bello and, when appropriate, to the jus post bellum, provide the international community with much of the information it needs to determine whether or not right intention has been met. [ABSTRACT FROM AUTHOR]

Utilitarianism is the strand of moral philosophy that holds that judgment of whether an act is morally right or wrong, hence whether it ought to be done or not, is primarily based upon the foreseen consequences of the act in question. It has a bad reputation in military ethics because it would supposedly make military expedience override all other concerns. Given that the utilitarian credo of 'the greatest happiness for the greatest number' is in fact 'agent-neutral', meaning that the consequences to everyone should weigh equally, this critique of utilitarianism is not entirely fair. By focusing on some anomalies in both the 'principle of double effect' and in our tendency to give priority to the interests of those who are near and dear to us, this article argues that there is something to be said for a military ethic that attaches less weight to intentions, and more to the consequences. [ABSTRACT FROM AUTHOR]

Baxter v. Montana (2009 WL 5155363 [Mont. 2009]) is a recent decision from the Montana Supreme Court that provides new legal insight into the societal issue of aid in dying. This case involves interests of persons with terminal illness, medical practitioners, law enforcement, legislative and judicial bodies, as well as the citizens of Montana. A summary judgment ruling at the Montana district court level was based almost entirely on a constitutional fundamental rights analysis. In contrast, the Montana Supreme Court affirming decision was based almost entirely on a statutory rights analysis. Both rulings from the Montana courts support the position that licensed prescribers in Montana who provide aid in dying assistance to terminally ill patients have some immunity from criminal prosecution. Each side in the case argued what they believed to be the intents and purposes of the people of Montana. Baxter v. Montana illustrates different methods to determine the will of the people concerning aid in dying and public policy. This case very subtly suggests a paradigm shift may be occurring in aid in dying policy. [ABSTRACT FROM AUTHOR]

At the end of life, all patients have the right to the adequate relief of physical symptoms. Consequently, there is need to ensure that appropriate infrastructural measures are addressed to enhance the likelihood that this right will be fulfilled. In order to achieve this, it is critical that symptoms at the end of life be assessed and, when relief is needed, that the adequacy of symptom relief be determined by the patient. Inadequately received symptoms in dying patients must be relieved to the patient's satisfaction and symptoms that are difficult to control must be evaluated by clinicians expert in symptom control at the end of life. When a symptom is refractory to normal palliative approaches, and only sedation can provide the needed relief, this should be available to patients with appropriate infrastructural guidelines to prevent the inappropriate application of this approach. [ABSTRACT FROM AUTHOR]

The complexities that converge around palliative sedation invite clinicians to work together to differentiate the issues and come to recommendations and decisions that are humane, ethical, legal, and clinically sound. Whether a crisis or long-term situation exists, the work is essentially the same. It must include critical thinking, clinical expertise, multidimensional assessment, and an array of interventions to assist patients and families in situations where symptoms and suffering are sufficiently intense to warrant exploration of sedation. The many issues inherent in the discussion of sedation at end of life require not that we have the answers but rather that we work with our colleagues to raise relevant questions and integrate both expertise and compassion into end-of-life decisions and care. [ABSTRACT FROM AUTHOR]

There is general agreement that the targeting of civilians in war is morally wrong. But sometimes starvation tactics are accepted as being a better option than direct military attacks. This article questions this view by arguing that starvation tactics affect civilians first and inflict long-term suffering. It argues that they are not just unless they can be limited to a small area where only military personnel will be affected. It looks at the provision for starvation tactics in the Geneva Conventions, and at the argument of double effect. It then illustrates the argument with three case studies: the siege of Leningrad; the application of sanctions prior to and during the Gulf War in 1990–1991; and restrictions of food during the war in Bosnia. [ABSTRACT FROM AUTHOR]

Since 1998, physician-assisted suicide has been legal in the American state of Oregon. In this paper, Idefend Oregon's physician-assisted suicide (PAS) law against two of the most common objections raised against it. First, I try to show that it is not intrinsically wrong for someone with a terminal disease to kill herself. Second, I try to show that it is not intrinsically wrong for physicians to assist someone with a terminal disease who has reasonable grounds for wanting to kill herself. [ABSTRACT FROM AUTHOR]

Modern warfare cannot be conducted without civilians being killed. In order to reconcile this fact with the principle of discrimination in just war theory, the principle is applied through the doctrine of double effect. But this doctrine is morally inadequate because it is too permissive regarding the risk to civilians. For this reason, Michael Walzer has suggested that the doctrine be supplemented with what he calls the idea of double intention: combatants are not only to refrain from intending to harm civilians; they are also to take precautions to reduce risk to civilians, even at the expense of increasing risk to themselves. The article develops the idea of double intention by addressing two questions: What does it mean to intend to reduce civilian risk, and how much should civilian risk be reduced? The results of this discussion are then used to consider a moral issue that arises in technologically asymmetric warfare, namely, the extent to which the use of precision-guided munitions, which allow more accurate targeting, can by itself bear the moral burden imposed by the principle of discrimination. [ABSTRACT FROM AUTHOR]