Two Cheers for “Closeness”: Terror, Targeting and Double Effect

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. Thanks to Thomas Flint, Paul Benacerraf, Mark Johnston, Gilbert Harman, Tom Cavanaugh, Jorge Garcia, Robert Audi and an anonymous referee for useful discussion and written comments.     

A Stronger Doctrine of Double Effect

Many believe that intended harms are more difficult to justify than are harms that result as a foreseen side effect of one's conduct. We describe cases of harming in which the harm is not intended, yet the harmful act nevertheless runs afoul of the intuitive moral constraint that governs intended harms. We note that these cases provide new and improved counterexamples to the so-called Simple View, according to which intentionally phi-ing requires intending to phi. We then give a new theory of the moral relevance of intention. This theory yields the traditional constraint on intending harm as a special case, along with several stronger demands.     

The role of conscious reasoning and intuition in moral judgment: testing three principles of harm

Is moral judgment accomplished by intuition or conscious reasoning? An answer demands a detailed account of the moral principles in question. We investigated three principles that guide moral judgments: (a) Harm caused by action is worse than harm caused by omission, (b) harm intended as the means to a goal is worse than harm foreseen as the side effect of a goal, and (c) harm involving physical contact with the victim is worse than harm involving no physical contact. Asking whether these principles are invoked to explain moral judgments, we found that subjects generally appealed to the first and third principles in their justifications, but not to the second. This finding has significance for methods and theories of moral psychology: The moral principles used in judgment must be directly compared with those articulated in justification, and doing so shows that some moral principles are available to conscious reasoning whereas others are not.     

The Intend/Foresee Distinction and the Problem of “Closeness”

The distinction between harm that is intended as a means or end, and harm that is merely a foreseen side-effect of one’s action, is widely cited as a significant factor in a variety of ethical contexts. Many use it, for example, to distinguish terrorist acts from certain acts of war that may have similar results as side-effects. Yet Bennett and others have argued that its application is so arbitrary that if it can be used to cast certain harmful actions in a more favorable light, then it can equally be manipulated to do the same for any kind of harmful action. In response, some have tried to block such extensions of the intend/foresee distinction by rejecting its application in cases where the relation between the plainly intended means and the harm is “too close”. This move, however, has been attacked as vague and obscure, and Bennett has argued that all the plausible candidates for explicating the idea of excessive closeness ultimately fail. In this paper, I develop and defend an account of excessive closeness with the aim of rescuing the intend/foresee distinction from such charges of arbitrariness. The account is based on the distinction between merely causal and constitutive relations among states of affairs, and I show both how it escapes Bennett’s objections to other accounts and how it applies to a variety of cases. Finally, I also examine Quinn’s alternative move of shifting the focus of the intend/foresee distinction in an attempt to sidestep the issue of closeness, and argue that it is not ultimately successful. In fact, Quinn’s view has shortcomings that can be resolved only by returning to an appeal to some notion of closeness, underscoring the need for the sort of account I offer.     

Actions, intentions, and consequences: the doctrine of double effect

One interpretation of the doctrine of double effect (DDE) holds that in situations in which good can be secured for some only if others suffer harm, the pursuit of a good tends to be less acceptable when a resulting harm is intended as a means rather than when it is merely foreseen. The doctrine captures certain moral intuitions about pairs of cases which have the same consequential profiles but in which the character of the intention differs. Quinn examines the DDE using three pairs of contrasting cases, two of which are medical examples: the "Direction of Resources" case and the "Guinea Pig" case, both involving allocation of life-saving resources, and the "Craniotomy" case and the "Hysterectomy" case, both involving fetal vs. maternal life. He concludes that the DDE "embodies our sense that certain forms of forced strategic subordination are especially inappropriate among free and equal agents."     

Intentions,foreseen consequences and the doctrine of double effect

The difficulty of distinguishing between the intended and the merely foreseen consequences of actions seems to many to be the most serious problem for the doctrine of double effect. It has led some to reject the doctrine altogether, and has left some of its defenders recasting it in entirely different terms. I argue that these responses are unnecessary. Using Bratman’s conception of intention, I distinguish the intended consequences of an action from the merely foreseen in a way that can be used to support the doctrine of double effect.     

Biases in children's and adults' moral judgments

Two experiments examined biases in children's (5/6- and 7/8-year-olds) and adults' moral judgments. Participants at all ages judged that it was worse to produce harm when harm occurred (a) through action rather than inaction (omission bias), (b) when physical contact with the victim was involved (physical contact principle), and (c) when the harm was produced as a direct means to an end rather than as an unintended but foreseeable side effect of the action (intention principle). The youngest participants, however, did not incorporate benefit when making judgments about situations in which harm to one individual resulted in benefit to five individuals. Older participants showed some preference for benefit resulting from action (commission) as opposed to inaction (omission). The findings are discussed in the context of the theory that moral judgments result, in part, from the operation of an inherent, intuitive moral faculty compared with the theory that moral judgments require development of necessary cognitive abilities.     

So Close,Yet So Far: Why Solutions to the Closeness Problem for the Doctrine of Double Effect Fall Short

According to the classical Doctrine of Double Effect (DDE), there is a morally significant difference between intending harm and merely foreseeing harm. Versions of DDE have been defended in a variety of creative ways, but there is one difficulty, the so‐called “closeness problem”, that continues to bedevil all of them. The problem is that an agent's intention can always be identified in such a fine‐grained way as to eliminate an intention to harm from almost any situation, including those that have been taken to be paradigmatic instances in which DDE applies to intended harm. In this paper, we consider and reject a number of recent attempts to solve the closeness problem. We argue that the failure of these proposals strongly suggests that the closeness problem is intractable, and that the distinction between intending harm and merely foreseeing harm is not morally significant. Further, we argue that there may be a deeper reason why such attempts must fail: the rationale that makes the best fit with DDE, namely, an imperative not to aim at evil, is itself irredeemably flawed. While we believe that these observations should lead us to abandon further attempts to solve the closeness problem for DDE, we also conclude by showing how a related principle that is supported by a distinct rationale and avoids facing the closeness problem altogether nevertheless shares with DDE its most important features, including an intuitive explanation of a number of cases and a commitment to the relevance of intentions.     

The Loop Case and Kamm’s Doctrine of Triple Effect

Judith Jarvis Thomson’s Loop Case is particularly significant in normative ethics because it questions 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.     

Defending Double Effect

According to the doctrine of double effect(DDE), there is a morally significantdifference between harm that is intended andharm that is merely foreseen and not intended.It is not difficult to explain why it is bad tointend harm as an end (you have a ``badattitude' toward that harm) but it is hard toexplain why it is bad to intend harm as a meansto some good end. If you intend harm as a meansto some good end, you need not have a ``badattitude' toward it. I distinguish two ways inwhich you can treat something that is yourchosen means to your ends. You can pursue yourends directly, and treat X as a mere means thatyou pursue for the sake of your end. Or you canpursue your ends indirectly, and treat X as a``plan-relative end' that you pursue for its ownsake. I argue that much of the time we pursueour ends indirectly, and treat our means asplan-relative ends. There are significantanalogies between intending harm as an end, andintending harm as a plan-relative end. So,under certain circumstances, it is morallyworse to intend harm as a means or an end thanto foresee bringing about the same amount of harm.     

The accomplishment of plans: a new version of the principle of double effect

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.     

Medical Ethics and Double effect: The Case of Terminal Sedation

The use of terminal sedation to control theintense discomfort of dying patients appearsboth to be an established practice inpalliative care and to run counter to the moraland legal norm that forbids health careprofessionals from intentionally killingpatients. This raises the worry that therequirements of established palliative care areincompatible with moral and legal opposition toeuthanasia. This paper explains how thedoctrine of double effect can be relied on todistinguish terminal sedation from euthanasia. The doctrine of double effect is rooted inCatholic moral casuistry, but its applicationin law and morality need not depend on theparticular framework in which it was developed. The paper further explains how the moral weightof the distinction between intended harms andmerely foreseen harms in the doctrine of doubleeffect can be justified by appeal to alimitation on the human capacity to pursue good.     

The Doctrine of Double Effect and Affirmative Action

ABSTRACT William Cooney has recently argued ( The Journal of Applied Philosophy , Vol. 6, pp. 201–204) that the social programme of affirmative action, though controversial, can be supported by the doctrine of double effect in that, according to the doctrine, responsibility falls on the side of intended consequences and not on that of unintended consequences. The point of affirmative action is to include certain disadvantaged groups; it is not to exclude other groups, though this is an inevitable and foreseeable by-product. In this article I contend that Cooney's argument ignores two important conditions of the doctrine of double effect; namely, that the good which results from the intended effect must be at least commensurate with the harm that results from the unintended effect; and, that the intended good effect is causally separate from the unintended harmful effect. Any use of the doctrine which neglects these conditions leads to morally problematic cases. Further, once we take the conditions into account, we have good reason to think that the doctrine of double effect has no relevance to the affirmative action debate.     

Patterns of moral judgment derive from nonmoral psychological representations

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 ( Cushman, Young, & Hauser, 2006 ). 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.     

Induced delivery of anencephalic fetuses: a response to James L. Walsh and Moira M. McQueen

James Walsh and Moira McQueen accurately conclude that the early delivery of anencephalic fetuses is morally acceptable, but the reasoning they use to reach that conclusion is flawed. First, the principle of double effect does not require a weighing of good and evil, but rather seeks a sufficient reason for tolerating the physical evil indirectly intended. Second, the principle of double effect requires a clear distinction between physical and moral causality. Third, the Catholic moral tradition will not admit direct and intended killing of the innocent. Rather, early delivery of anencephalic fetuses is permissible because of the pathology associated with delivery of anencephalic fetuses at full term. Thus, the early delivery of an anencephalic infant is acceptable if the purpose of the moral act is avoiding a pathological condition on the part of the mother.     

Non-heart-beating donors of organs: are the distinctions between direct and indirect effects & between killing and letting die relevant and helpful?

This essay analyzes the principle of double effect and, to a lesser extent, the distinction between killing and letting die in the context of the Pittsburgh protocol for managing patients who may become non-heart-beating donors or sources of organs for transplantation. It notes several ambiguities and unresolved issues in the Pittsburgh protocol but concludes that neither the principle of double effect nor the distinction between killing and letting die (with the prohibition of the former and the allowance of the latter under some circumstances) erects insurmountable obstacles to the implementation of the protocol. Nevertheless, the requirement of the principle of double effect that the intended good effects outweigh the unintended side effects necessitates careful attention to the probable overall impact of the proposed policy on organ procurement, particularly because public mistrust plays such a significant role in limiting the number of organ donations.     

Intention and Responsibility in Double Effect Cases

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.     

How to Respond to the Problem of Deviant Formal Causation

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.     

What makes placebo-controlled trials unethical?

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm.