Thomas Cavanaugh

In contemporary ethical discourse generally, and in discussions concerning the legalization of physician‐assisted suicide (PAS) and voluntary active euthanasia (VAE) specifically, recourse is sometimes had to the Nazi! accusation. Some disputants charge that such practices are or will become equivalent to the Nazi ‘euthanasia’ program in which over 73,000 handicapped children and adults were killed without consent. This paper reflects on the circumstances that lead to the use of this charge and offers reasons for putting the Nazi! charge aside in contemporary discussions of PAS and VAE. A number of the philosophical presuppositions common to both the Nazi ‘euthanasia’ program and the currently proposed practices of PAS and VAE are examined. Noting that racist ideology and violent coercion characterized the Nazi program, the paper concludes with a cautionary consideration of the current circumstances that would specify PAS and VAE in the US.

In what follows, I reply to critical appraisals of my book entitled Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. Professors Tollefsen, McPherson, and Potts separately offer these thoughtful critiques. Professor Tollefsen approaches the work from the standpoint of the physician-patient relationship. Professors McPherson and Potts both address it in terms of virtues. Potts treats the theme of virtue generally while McPherson focuses on the virtue of piety. Since virtues attend relationships, in what follows, I discuss, first, the physician-patient relationship ; second, virtue generally ; and third, and finally, the virtue of piety specifically.

Common morality endorses some form of an exceptionless prohibition against killing innocents. Natural lawyers employ double-effect reasoning to address hard cases involving deaths of the innocent. Current deontologists criticize DER-proponents as conflating act-with agent-evaluations. Scanlon develops this critique extensively. I respond to his criticism. He maintains that the DER-advocate tells a badly-motivated agent to refrain from an obligatory act. Thus, he asserts, the natural lawyer who employs DER errs. Instead, Scanlon proposes, one ought to assess the act as permissible while blaming the agent. I argue that DER does not succumb to this critique. Moreover, Scanlon’s particular criticism nicely shows the reasonableness of the approach the DER-thinker takes, namely, that defective agents produce defective acts. Thus, employing DER does not lead to a confusion of act-with agent-evaluations. Rather, it results in coherent assessments of both.

Double effect reasoning is a nonconsequentialist analysis of the ethical status of an agent's acting to realize an end which is ethically in the clear when the realization of such an end inextricably causes some effect the causing of which is, prima facie, not ethically in the clear. In this work, I remove certain misunderstandings which attend discussions of DER: the relation between contemporary accounts and Aquinas's originating account , the relation between the intended/foreseen distinction operative in DER and the doing/allowing distinction, and the various and misleading names given to the i/f distinction , I criticize the accounts of contemporary theorists of DER, e.g., Warren Quinn and Joseph Boyle. In my positive account, I solve the 'problem of closeness' presented by Philippa Foot. I argue that the i/f distinction is tenable, ethically significant, and applicable to the cases usually dealt with in contemporary accounts of DER . I argue that the i/f distinction belongs to a larger account of intention which attends to the relations between intention and deliberation . Noting that DER is not simply the i/f distinction , I argue that DER in part depends upon the relations between an agent's various responsibilities vis-a-vis the good and bad which he will conjointly effect in the cases to which DER applies. I argue that DER does not result in a conclusion which tells the agent what he must do, but, rather, in one indicating that a course of action is ethically in the clear.