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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 So we aimed to determine how robust the means/byproduct effect is by conducting a meta-analysis of both published and unpublished studies (k=101; 24,058 participants).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. [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]

The “principle of double effect” is a vital tool for moral decision making and is applicable to all areas of medical practice, including (for example) end-of-life care, transplant medicine, and cases of conscientious objection. Both our ultimate and our more immediate intentions are relevant in making and evaluating choices—though side effects must be kept proportionate and can be morally conclusive when linked with some intentions. Intentions help to form the character of doctors, and of human beings generally. While hypocrisy is certainly possible in regard to this form (and other forms) of moral reasoning, double effect reasoning, sincerely practised, remains indispensable in identifying moral problems and solutions. [ABSTRACT FROM AUTHOR]

In this paper, we defend the general thesis that intentions are relevant not only to moral permissibility and impermissibility, but also to criminal wrongdoing, as well as a specific version of the Doctrine of Double Effect that we believe can help solve some challenging puzzles in the criminal law. We begin by answering some recent arguments that marginalize or eliminate the role of intentions as components of criminal wrongdoing [e.g., Alexander and Ferzan (Crime and culpability: a theory of criminal law. Cambridge University Press, New York, 2009), Chiao (Crim Law Philos 4:37-55, 2010), Walen (Crim Law Philos 3:71-78, 2009)]. We then turn to some influential theories that articulate a direct role for intentions [e.g., Duff (Answering for crime: responsibility and liability in the criminal law. Hart Publishing, Portland, 2007), Husak (Crim Law Philos 3:51-70, 2009)]. While we endorse the commitment to such a role for intentions, we believe that extant theories have not yet been able to adequately address certain objections or solve certain puzzles, such as that some attempt convictions require criminal intent when the crime attempted, if successful, requires only foresight, and that some intended harms appear to be no more serious than non-intended ones of the same magnitude, for example. Drawing on a variety of resources, including the specific version of the Doctrine of Double Effect we have developed in recent published work, we present solutions to these puzzles, which in turn provide mutual support for our general approach to the role of intentions and for thinking that using others as means is itself a special kind of wrongdoing. [ABSTRACT FROM AUTHOR]

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Feminist critiques of intention challenge some aspects of traditional just war reasoning, including the criteria of right intention and discrimination (particularly as interpreted using the doctrine of double effect). I take note of these challenges and propose some directions just war reasoners might take in response. First, right intention can be evaluated more accurately by judging what actors in war actually do than by attempting to uncover inward dispositions. Assessing whether agents in war have taken due care to minimize foreseeable collateral damage, avoided intentional targeting of noncombatants, corrected previous mistakes in their later actions, and taken responsibility to repair unintended damage they cause are examples of ways in which just war reasoners can evaluate intention by looking at actions. [ABSTRACT FROM AUTHOR]

Proportionalist reasoning, found in the Aristotelian Just War theory, moderates the means taken by reference to the intended (moral) end. However, judging acts by their conformity or otherwise to one normative moral end might, in a liberal society, seem an imposition. Against this objection, I argue, with Spaemann, that values associated with the culture of commerce and its ethical theories are a breakaway from the culture of commitment and virtue that is the only possible framework for ethical reasoning. This commitment is unpacked by MacIntyre through the idea of a social practice and its internal goods. Applied to business, it is work itself, normatively conceived, that is the key internal good. [ABSTRACT FROM AUTHOR]

An externalist view of intention is developed on broadly Wittgensteinian grounds, and applied to show that the classic Thomist doctrine of double effect, though it has good uses in casuistry, has also been overused because of the internalism about intention that has generally been presupposed by its users. We need a good criterion of what counts as the content of our intentional actions; I argue, again on Wittgensteinian grounds, that the best criterion comes not from foresight, nor from foresight plus some degree of probability, nor from any metaphysics of "closeness", but simply from our ordinary shared understanding of what counts as doing a given action, and what does not. [ABSTRACT FROM AUTHOR]

Recently, a new problem has arisen for an Anscombean conception of intentional action. The claim is that the Anscombean's emphasis on the formally causal character of practical knowledge precludes distinguishing between an aim and a merely foreseen side effect. I propose a solution to this problem: the difference between aim and side effect should be understood in terms of the familiar Anscombean distinction between acting intentionally and the intention with which one acts. I also argue that this solution has advantages over an alternative that has already been endorsed in the literature: it is a better fit for the Anscombean theory, and it naturally accommodates intuitions about the moral significance of aiming vs. merely foreseeing. [ABSTRACT FROM AUTHOR]

The classical principle of double effect offers permissibility conditions for actions foreseen to lead to evil outcomes. I shall argue that certain kinds of closeness cases, as well as general heuristic considerations about the order of explanation, lead us to replace the intensional concept of intention with the extensional concept of accomplishment in double effect. [ABSTRACT FROM AUTHOR]

Scanlon () has argued that his theory of permissibility (STP) has more explanatory power than the Doctrine of Double Effect (DDE). I believe this claim is wrong. Borrowing Michael Walzer's method of inquiry, I will evaluate the explanatory virtue of these accounts by their understanding of actual moral intuitions originated in historical cases. Practically, I will evaluate these accounts as they explain cases of hostage crises. The main question in this context is: is it permissible that nation-states act with military force in order to liberate hostages, even if those actions put the lives of the hostages at risk? The first part of this paper has an operative reconstruction of the relevant theories. In the second section, two cases of hostage crises will be considered: the Moscow theater hostage crisis of 2002, and the Jaque Operation, which occurred in Colombia in 2008. Additionally, it will be shown that DDE explains these cases better than STP. Finally, this paper offers a critical analysis of Scanlon's account of the explanatory power of both STP and DDE. [ABSTRACT FROM AUTHOR]

In this paper, I argue that the doctrine of double effect is disposed toward abuse. I try to identify two distinct sources of abuse of double effect: the conditions associated with standard formulations of double effect and the difficulty of fully understanding one’s own intentions in action. Both of these sources of abuse are exacerbated in complex circumstances, where double effect is most often employed. I raise this concern about abuse not as a criticism of double effect but rather as a problem that defenders should observe and try to prevent. I go on to suggest certain methods for avoiding the abuse of double effect such as hesitating to use it, applying it only with other agents, and selectively and carefully propagating it. [ABSTRACT FROM PUBLISHER]

According to the Principle of Double Effect (PDE), there are conditions under which it would be morally justifiable to cause some harm as a foreseen side-effect of one's action even though it would not be justifiable to form and execute the intention of causing the same harm. If we take the kind of justification in question to be that of moral permissibility, this principle correctly maps common intuitions about when it would be permissible to act in certain ways. T.M. Scanlon argues that the PDE so interpreted is problematic, as it returns implausible verdicts in other scenarios. Scanlon is unable to account for the common pattern of moral reasoning that we employ in the relevant cases. I argue that we can account for this pattern while avoiding implausible verdicts if we interpret the PDE as a principle about when it is licit to inflict harm rather than when it is permissible to do so, and if we connect the concept of the licit with that of the permissible in the right way. [ABSTRACT FROM AUTHOR]

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]

The papers in the 2010 “Clinical Ethics” number of the Journal of Medicine and Philosophy explore issues along La Frontera, the borders and boundaries of clinical ethics. The first three papers in this “Clinical Ethics” number of the Journal explore borders and boundaries drawn within clinical ethics, concerning the moral standing of complementary and alternative medicine, palliative sedation, and induced abortion and feticide. The fourth and fifth papers explore the borders and boundaries between research ethics and clinical ethics. [ABSTRACT FROM PUBLISHER]

It is often claimed that the intentions of physicians are multiple, ambiguous, and uncertain—at least with respect to end-of-life care. This claim provides support for the conclusion that the principle of double effect is of little or no value as a guide to end-of-life pain management. This paper critically discusses this claim. It argues that proponents of the claim fail to distinguish two different senses of “intention,” and that, as a result, they are led to exaggerate the extent to which clinical intentions in end-of-life contexts are ambiguous and uncertain. It argues further that physicians, like others who make life and death decisions, have a duty to get clear on what their intentions are. Finally, it argues that even if the principle of double effect should be rejected, clinical intentions remain ethically significant because they condition the meaning of extraordinary clinical interventions, such as that of palliative sedation. [ABSTRACT FROM PUBLISHER]

Abstract: The Doctrine of Double Effect has been described as often used in medicine and surgery but is seldom described outside the palliative medicine context. This paper presents a possible clinically focussed illustration of the doctrine of double effect used in an acute urological setting. The authors describe the case of an elderly patient with significant dementia and haematuria who required anticoagulation. Implicit double effect reasoning may have helped the surgical team reach their initial decision with regard to a treatment plan, reconciling a duty to beneficence with a duty not to cause harm. This short case is offered as a stimulus for further discussion over the role of duty-based ethical reasoning in the acute surgical setting. It also highlights a possible need for more detailed case-analysis in identifying areas of interest in surgical ethics. [Copyright &y& Elsevier]

SUMMARY: One of the major challenges for intensivists is resolving the conflicting interests in end-of-life care. We reviewed patients'' characteristics in an intensive care unit to determine the major barriers of practicing good end-of-life care and the medical ethics involved for the care team to resolve these conflicts. [Copyright &y& Elsevier]

Richard McCormick justified his move to proportionalism in part because of the perceived inadequacy of the Grisez-Finnis approach to morality to answer the following question: "What is to count for turning against a basic good, and why?" In this paper, Iprovide the beginnings of an account of what it means to intend damage to a good; I then show that the account is readily exportable to judgments regarding killing and lying defended by Grisez and others. I then indicate that the account comports well with some of what Grisez says about sexual morality and suggest areas in which further clarification is necessary. In thus proceeding, I hope to inoculate the Grisez view from McCormick's reservations. [ABSTRACT FROM AUTHOR]

At the start of her vigorously argued and classic article, "Modern Moral Philosophy, "G. E. M. Anscombe stated threefocal theses. First, that philosophers of the time needed to dispense with investigation into talk of what is morally right, wrong; permissible, forbidden, required; and of moral obligation or duty, what we morally ought to do. Second, there was nq adequate philosophical psychology then available of the sort neededfor doing good moral philosophy. Third, the differences among the modernist moral philosophers (from, roughly, Hume's time through the mid-2Oth century) that had been most widely discussed were not as important as what they agreed on. I wish here to make some remarks about the sequel. More specifically, I will briefly discuss some aspects of how things have since played out with the first two theses, in order to say something about the relation between the first and second theses and about the state of things with respect to her third thesis, especially as it impacts today's medical ethics, afield of inquiiy that barely existed at the time Anscombe wrote "Modern Moral Philosophy." [ABSTRACT FROM AUTHOR]

Philosophers from Hart to Lewis, Johnston and Bennett have expressed various degrees of reservation concerning the doctrine of double effect. A common concern is that, with regard to many activities that double effect is traditionally thought to prohibit, what might at first look to be a directly intended bad effect is really, on closer examination, a directly intended neutral effect that is closely connected to a foreseen bad effect. This essay examines the extent to which the commonsense concept of intention supports a reasonably consistent and coherent application of double effect. Two important conclusions are these: (1) a number of traditionally proscribed activities involve a kind of “targeting” of innocents that can be taken to exhibit a direct intention to harm them; (2) a direct intention to harm need not involve a desire to harm in any ordinary sense of the latter expression. [ABSTRACT FROM AUTHOR]

This article examines the relationship between the principle of double effect and justification for separation surgeries for conjoined twins. First, the principle of double effect is examined in light of its historical context. It is argued that it can only operate under an absolutist view of good and evil that is compatible with the Bible. Given this foundation for application, scenarios for separating conjoined twins are considered against the criteria for the principle of double effect. It is concluded that the principle of double effect cannot be applied to cases wherein one of the twins must be killed. However, it is noted that this does not leave decision makers without options. [ABSTRACT FROM AUTHOR]

There are two perspectives available from which to understand an agent's intention in acting. The first is the perspective of the acting agent: what did she take to be her end, and the means necessary to achieve that end? The other is a third person perspective that is attentive to causal or conceptual relations: was some causal outcome of the agent's action sufficiently close, or so conceptually related, to what the agent did that it should be considered part of her intention? Recent goods based views in ethics are divided as to whether only the first person perspective, or a mix of both perspectives, are necessary to understand intention and action. But resolution of the issue is necessary if goods based views are to be able to deploy to principle of double effect; for that principle requires an account of how to distinguish what is genuinely a matter of intention in human action from what is not. I argue that the pure first person account is better than the mixed account. [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]

The ethical doctrine of double effect permits health care professionals to administer potentially fatal medication, provided that their intentions are purely to control symptoms. In this article, the legal status and scope of the doctrine will be analysed, and it will be argued that the law in this context is unclear, incoherent and partial in its application. The problems are not exclusively legal in nature, however, because health professionals have been critical both of the doctrine itself and of the lawyers' understanding of the concept. It will be concluded that clarification and appropriate enforcement are needed if the doctrine and the law are to retain credibility. [ABSTRACT FROM AUTHOR]

If one accepts a version of absolutism that excludes the intentional killing of any innocent human person from conception to natural death, ectopic pregnancy poses vexing difficulties. Given that the embryonic life almost certainly will die anyway, how can one retain one's moral principle and yet adequately respond to a situation that gravely threatens the life of the mother and her future fertility? The four options of treatment most often discussed in the literature are non-intervention, salpingectomy (removal of tube with embryo), salpingostomy (removal of embryo alone), and use of methotrexate (MXT). In this essay, I review these four options and introduce a fifth (the milking technique). In order to assess these options in terms of the absolutism mentioned, it will also be necessary to discuss various accounts of the intention/foresight distinction. I conclude that salpingectomy, salpingostomy, and the milking technique are compatible with absolutist presuppositions, but not the use of methotrexate. [ABSTRACT FROM AUTHOR]

I argue that the moral distinction in double effect cases rests on a difference not in intention as traditionally stated in the Doctrine of Double Effect (DDE), but in desire. The traditional DDE has difficulty ensuring that an agent intends the bad effect just in those cases where what he does is morally objectionable. I show firstly that the mental state of a rational agent who is certain that a side-effect will occur satisfies Bratman's criteria for intending that effect. I then clarify the nature of the moral distinction in double effect cases and how it can be used to evaluate the moral blameworthiness of agents rather than the moral status of acts. The agent's blameworthiness is reduced not by his lack of intention but by his desire not to bring about the side-effect, and the 'counterfactual test' can be used to determine whether he desires the effect in acting. In my version, the DDE has its rationale in virtue ethics; it is not liable to abuse as the traditional version is; and it makes more plausible distinctions when applied to standard examples. [ABSTRACT FROM AUTHOR]

The authors comment on the article "Humane Terminal Extubation Reconsidered: The Role for Preemptive Analgesia and Sedation," by J. A. Billings, that was published within the issue. They enumerate circumstances that allow the use of the Doctrine of Double Effect (DDE) in the U.S. including intending a good effect. They cite the role of the values of a family regarding terminal extubation. They negate the notion that balancing risks is an objective medical decision to be made by the physician.