Relieving Pain and Foreseeing Death: A Paradox about Accountability and Blame

Whether it is in fact the morphine that kills has been questioned ( Kolata G. , “When Morphine Fails to Kill,” New York Times, July 23, 1997, at B10). But this unresolved empirical matter does not affect our argument.

In the Hippocratic Oath, the physician swears, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect” and “I will keep [the sick] from harm and injustice….”

Throughout, “harm” refers to injurious deprivations such as loss of life, health, property, or privacy, and we draw no distinction between duties and obligations.

In contemporary discussions, some versions of what we here call “the Doctrine of Double Effect” have been defended by Grisez G. , “Toward a Consistent Natural-Law Ethics of Killing,” The American Journal of Jurisprudence, 15 (1970): 64–96; and Devine P. , The Ethics of Homicide (Ithaca: Cornell University Press, 1978), at 106–33, among others. See also Foot P. , “Morality, Action, and Outcome,” in Honderich T. , ed., Morality and Objectivity (London: Routledge & Kegan Paul, 1985); and Quinn W.S. , “Actions, Intentions, and Consequences: The Doctrine of Double Effect,” Philosophy and Public Affairs, 18 (1989): 334–51.

Foot P. , “The Problem of Abortion and the Doctrine of Double Effect,” The Oxford Review, 5 (1967): 5–15.

This version, suggested by Quinn (supra note 4, at 334), is sufficient for our purposes here, and it is what we shall mean by “the Doctrine of Double Effect.”

Hart H.L.A. , “Intention and Punishment,” The Oxford Review, 4 Hilary (1967): 5–22.

The case is, for instance, in Bennett J. , “Morality and Consequences,” in McMurrin S.M. , ed., The Tanner Lectures on Human Values (Cambridge: Cambridge University Press, 1980); and in his The Act Itself (Oxford: Clarendon Press, 1995): At 194–225. See also Quinn , supra note 4; and Bratman M. , Intention, Plans, and Practical Reason (Cambridge, MA: Harvard University Press, 1987): At 139–64.

This is a notorious problem for the theory when applied to certain cases of abortion to save the mother's life. See Kuhse H. , The Sanctity of Life Doctrine in Medicine: A Critique (Oxford: Clarendon Press, 1987): At 94–5.

We of course leave open the possibility that it is justified in some other way. It might, for example, be doubted whether death is a harm in the envisioned case, in view of the alternative. See Beauchamp T.L. Childress J.F. , Principles of Biomedical Ethics, 4th Ed. (New York: Oxford University Press, 1994): At 28, 210, 233.

Similarly, Bentham J. , in Introduction to the Principles of Morals and Legislation [1789] (New York: Hafner, 1946), distinguishes between consequences that are “immediately intended” (either as end or as means) and those that are only “obliquely intended” (i.e., foreseen as likely).

Kuhse , supra note 9.

Williams G. , The Sanctity of Life and the Criminal Law (New York: Alfred Knopf, 1970): At 203.

Hart H.L.A. , “Are There Any Natural Rights?” Philosophical Review, 64 (1955): 175–91.

Feldman R. , “Epistemic Obligations,” in Tomberlin J. , ed., Philosophical Perspectives (Atascadero, CA: Ridgeview, 1988): At 235–56. See also Stocker M. , “‘Ought’ and ‘Can,’” Australasian Journal of Philosophy, 49 (1971): 303–16.

For a different view on this, see Stocker , supra note 15; and Kekes J. , “‘Ought’ Implies ‘Can’ and Two Kinds of Morality,” Philosophical Quarterly, 34 (1984): 460–67.

See, for example, Kass L. , “Neither for Love nor Money: Why Doctors Must Not Kill,” Public Interest, 94 (1989): 25–46; and Pellegrino E. , “Doctors Must Not Kill,” in Misbin R. , ed., Euthanasia: The Good of the Patient, the Good of Society (Frederick, MD: University Publishing Group, 1992): At 27–41. See also Gaylin W. Kass L. Pellegrino E. Siegler M. , “Doctors Must Not Kill,” JAMA, 259 (1988), 14: 2139–40; and Baumrin B. , “Physican, Stay thy Hand!” in Battin M. Rhodes R. Silvers A. , eds., Physician Assisted Suicide: Expanding the Debate (New York: Routledge, 1998): At 177–81.

See, for example, Kamm F.M. , “Physician-Assisted Suicide, Euthanasia, and Intending Death,” in Battin , supra note 17: At 28–62. See also Williams G. , supra note 13; and Rachels J. , The End of Life: Euthanasia and Morality (Oxford: Oxford University Press, 1986); and Beauchamp Childress , supra note 10.

See, for example, Chisholm R. , Person and Object (LaSalle, IL: Open Court, 1976): At 74–75; Harman G. , “Rational Action and the Extent of Intentions,” Social Theory and Practice, 9 (1983): 123–41; and Bratman M. , supra note 8: At 139–64.