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This article articulates the Hippocratic medical ethic found in the Oath and the Christian medical ethic as exemplified in the parable of the Good Samaritan. It proposes that the Oath has a natural-law-based deontological character that governs friendships of utility between student and teacher and physician and patient. The article elaborates on the Samaritan’s conduct as exemplifying Christian agapeic-love. It contrasts agapeic-love with friendship-love, while noting that the Samaritan relies on friendship-love to realize agapeic-love towards the robbers’ victim. It concludes with noting that the grace-based Christian medical ethic perfects the nature-based Hippocratic ethic not by destroying it, but, rather, by employing it.

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.

In “Modern Moral Philosophy” Anscombe argues that the distinction between intention of an end or means and foresight of a consequentially comparable outcome proves crucial in act-evaluation. The deontologist J. J. Thomson disagrees. She asserts that Anscombe mistakes the distinction’s moral import; it bears on agent-evaluation, not act-evaluation. I map out the contours of this dispute. I show that it implicates other disagreements, some to be expected and others not to be expected. Amongst the expected, one finds the ethicists’ accounts of action and understanding of how agent-assessment relates to act-assessment. Amongst the unexpected, one finds the moralists’ views about the possibility of self-imposed moral dilemmas and allied positions concerning temporal aspects of “ought implies can.” Anscombe’s employment of the distinction in act-evaluation withstands close scrutiny; Thomson’s denial of it does not.

If viable, DER justifies certain individual acts that—by definition—have two effects. Presumably, it would in some fashion justify policies concerning the very same acts. By contrast, acts that sometimes have a good effect and sometimes have a bad effect do not have the requisite two effects such that DER can justify them immediately. Yet, a policy concerning numerous such acts would have the requisite good and bad effects. For while any one such act would lack the relevant two effects, a series of such acts and a policy governing such a series would have them. This paper addresses DER’s justification of policies that apply to such acts. It shows that there are certain acts which DER mediately justifies by justifying policies concerning them. Thus, it recommends the larger topic of DER’s bearing on policy.

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.

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

By analogy to justifications offered for craniotomy by Catholic moralists, a recent instance of casuistry attempts to apply double-effect reasoning and, separately, the concept of a vital conflict to justify dilation and curettage in order to preserve the life of a pregnant woman. This paper examines and rejects these bases for justifying craniotomy and D&C. It concludes with a consideration of Pope John Paul II’s discussion of moral martyrdom in Veritatis splendor. National Catholic Bioethics Quarterly 11.3 : 453–463.

Much of Roman Catholic discussion concerning bioethical controversies, such as the surgical removal of a life-threatening cancerous uterus when the fetus is not viable, has focused on the employment of double-effect reasoning. While double-effect reasoning has been the subject of much debate, this paper argues first, that there is a distinction between the intended and the foreseen; second, that this distinction applies to the contrasted cases in such a way as to categorize foreseen but not intended consequences; and third, that this intended/foreseen distinction has essential ethical significance

A number of common and generally noncontroversial practices in the care of patients at the end of life lead to their deaths. For example, physicians honor a patient's refusal of medical intervention even when doing so leads to the patient's death. Similarly, with a patient's or surrogate's consent, physicians administer sedatives in order to relieve pain and distress at the end of life, even when it is known that doing so will cause the patient's death. In contemporary U.S. public policy, these practices are accepted as ethical and legal while physician-assisted suicide (PAS) isrejected in current U.S. law and public policy. Some think, however, that if one accepts practices that are known to lead to a patient's death, then one cannot reasonably reject a patient's request for a lethal dose of medication so that she may kill herself (PAS)

Proponents commonly justify the legalization of physician-assisted suicide (PAS) in terms of a patient's wanting to die (autonomy) and the patient's having a medically established good reason for suicide. These are the common elements of the standard justification offered for the legalization of PAS. In what follows, I argue that these two conditions exist in significant tension with one another, operating according to distinct dynamics that render the justification for PAS an unstable basis for public policy. Moreover, no natural connection keeps these two criteria united. Indeedthe two elements of the justification oppose and threaten to exclude one another. Thus, the PAS justification is too labile a basis for sound public policy

This paper argues that the current stock of anti-personnel cluster bombs are temporally indiscriminate, and, therefore, unjust weapons. The paper introduces and explains the idea of temporal indiscriminateness. It argues that to honor non-combatant immunity—in addition to not targeting civilians—one must adequately target combatants. Due to their high dud rate, cluster submunitions fail to target combatants with sufficient temporal accuracy, and, thereby, result in avoidable serious harm to non-combatants. The paper concludes that non-combatant immunity and the principle of discrimination require a moratorium on the use of current cluster munitions.