Actions, Intentions, and Consequences: The Doctrine of Double Effect
Warren S. Quinn
The article discusses situations in which the outcomes (in terms of lives lost or harm caused) of two scenarios are the same, but there seems to be some intuitive moral difference between them – in particular, the situation in which the harm caused was intentional is thought to be worse than the situation in which it was only foreseen, but not intentional. Quinn suggests that the difference between these two types of situations may be based on whether they intend to use other people, against their will, to achieve their desired ends. Quinn suggests that this situation is worse because it shows less respect for people’s ability to choose whether or not to assist in someone else’s plans – a theory that agrees with Kant’s formulation.
The Doctrine of Double Effect aims to capture moral intuitions about differences in situations that seem to have the same consequences as far as lives lost and harms suffered. It discriminates against action in which there is some kind of intending of an objectionable outcome as conductive to the agent’s end, and it discriminates in favor of an action that involves only foreseeing, but not intending, an objectionable outcome. Three pairs of scenarios are given to illustrate:
Strategic Bomber (SB) vs. Terror Bomber (TB
In the Case of the Strategic Bomber (SB), a pilot bombs an enemy factory in order to destroy its productive capacity. But in doing this he foresees that he will kill innocent civilians who live nearby. The Terror Bomber (TB) deliberately kills innocent civilians in order to demoralize the enemy.
Direction of Resources (DR) vs. Guinea Pig (GP)
In both there is a shortage of resources for the investigation and proper treatment of a new, life-threatening disease. In the first scenario doctors decide to cope by selectively treating only those who can be cured most easily, leaving the more stubborn cases untreated. Call this the Direction of Resources Case (DR). In the contrasting and intuitively more problematic example, doctors decide on a crash experimental program in which they deliberately leave the stubborn cases untreated in order to learn more about the nature of the disease. By this strategy they reasonable expect to do as much long-term medical good as they would in DR. Call this the Guinea Pig Case (GP). In neither case do the nontreated know about or consent to the decision against treating them.
Craniotomy Case (CC) vs. Hysterectomy Case (HC)
In the Craniotomy Case (CC) a woman will die unless the head of the fetus she is trying to deliver is crushed. But the fetus may be safely removed if the mother is allowed to die. In the Hysterectomy Case
(HC), a pregnant mother's uterus is cancerous and must be removed if she is to be saved. This will, given the limits of available medical technology, kill the fetus. But if no operation is performed the mother will eventually die after giving birth to a healthy infant.
Some of the major differences in these cases are he need of the agents for the victims. For example, in GP, the doctors need to have the disease continue in the victims to study its effects. In TB, the pilot needs the deaths of the civilians to lower enemy morale. It may be true that the terrorist is not directly interested in the deaths of civilians – he wouldn’t mind if they were magically resurrected after the war – he only needs to create the appearance of death and destruction. However, even if this objection is allowed, it is still true that the civilians’ involvement is critical to his plan.
There are a number of possible ways of making the distinction between the cases. One could base it on what was intended in each case, but this could be viewed differently depending on how the choice is described. Similarly, an effort to examine how closely linked the choices are to the death or harm would have subjective aspects and often would not help make distinctions between the cases.
One researcher suggested asking ‘why’ an agent is doing something. If that agent answers in the form, ‘to…’ then he accepts the question and shows that the choice was intentional. If he rejects the question, with an answer of the form, ‘it couldn’t be helped…’ or ‘I don’t care about that,’ then the choice was unintentional. However, this may not work in all cases. The DR doctors, if asked why they didn’t treat one group, may respond, “to save our resources for the more easily treated cases.” On the other hand, the terror bomber may say “the actual deaths couldn’t be helped if I’m to create the appearance of death and destruction.” So this method doesn’t seem productive.
A more promising method of distinguishing among these scenarios is to look at the intentional structures of the contrasting cases – i.e. in some cases, harm comes to the victim through deliberately involving them to further his purpose, while in others the victims are not central to the agent’s purpose. The first instance is one of direct harm and the second of indirect harm. For example, the TB intends for the civilians to be involved in a certain explosion, while the SB intends an explosion, and is aware that it will kill civilians, but their involvement is not related to his purpose.
Another distinction can be made between harmful exploitation and harmful elimination. In the CC case, the doctor is eliminating an obstacle, rather than exploiting individuals. This may be why the CC and HC cases are seen as different than the others by many people. Following on this theory, we can think about the case of hostages. Does shooting through or running over hostages involve a direct intention to harm them? Quinn suggests not. He argues that if they were not there, we would act in exactly the same way – shooting/driving, to get the criminal. Despite this conclusion, Quinn points out that the effect of the DDE doctrine should be to raise rather than lower moral barriers. It should show how much worse direct agency is, not allow people to become more tolerant of indirect agency.
Quinn argues that the most promising rationale may rest on special duties of respect for persons – over and above duty not to harm them – not just giving victims interests too little weight. Someone who causes harm by direct agency treats the victims as if they were there for his purpose – the victims are made to play a role in the service of the agents goal. Discriminating against this type of action reflects a Kantian ideal of human community and interaction – that each person be treated as an ends, and not as a means.