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Double Trouble, or Double Effect?

A couple of weeks ago at First Things' On the Square blog, George Weigel defended the prinicple of double-effect against attempts to apply it to the Phoenix case, in which Bishop Olmstead determined that St. Joseph's hospital had carried out a direct abortion. The argument in favor of applying it is presumably that the woman's life was in imminent danger, and that therefore the baby could be aborted as an unfortunate and foreseen, but unintended, bad effect of saving the woman's life, an unquestionable good.

Weigel, quoting the National Catholic Bioethics Center, reminds us of the principle's particulars:

The principle of double effect in the Church’s moral tradition teaches that one may perform a good action even if it is foreseen that a bad effect will arise only if four conditions are met: 1) The act itself must be good. 2) The only thing that one can intend is the good act, not the foreseen but unintended bad effect. 3) The good effect cannot arise from the bad effect; otherwise, one would do evil to achieve good. 4) The unintended but foreseen bad effect cannot be disproportionate to the good being performed.

The problem, obviously, is that in the Phoenix case all four points have likely been violated. Weigel (again drawing from the NCBC) then offers a scenario in which he believes the principle would validly apply:

The classic case of a difficult pregnancy to which this principle can be applied is the pregnant woman who has advanced uterine cancer. The removal of the cancerous uterus will result in the death of the baby but it would be permissible under the principle of double effect.

One can see how the conditions would be satisfied in this case: 1) The act itself is good; it is the removal of a diseased organ. 2) All that one intends is the removal of the diseased organ. One does not want the death of the baby, either as a means or an end. Nonetheless, one sees that the unborn child will die as a result of the removal of the diseased organ. 3) The good action, the healing of the woman, arises from the removal of the diseased uterus, not from the regrettable death of the baby which is foreseen and unintended. 4) The unintended and indirect death of the child is not disproportionate to the good which is done, which is saving the mother’s life.

I'm not sure why the uterine cancer has to be "advanced," but still: In applying the principle to this example, is Weigel correct?

Comments (82)

The link doesn't work, Bill. Do I understand correctly that Weigel is saying double effect _doesn't_ apply to the Phoenix case?

I guess Weigel is thinking the cancer has to be advanced because if it weren't advanced there would be less risk to the woman in waiting until the child was born.

No, I don't think he's correct that it would be allowable to remove the cancerous uterus, because you're cutting the child out of his only source of oxygen (his mother's body), when he will certainly die. Wait until the third trimester and perform a C-section after the child is viable, _then_ remove the cancerous uterus.

Lydia -
probably specifically "advanced" to avoid the solution you point out-- an "act now or the woman will not survive" situation. (I don't know what the standards are now, but a decade ago when my mom was going through the breast cancer thing, surgical removal was a sort of last-ditch effort.)

If the cancer wasn't advanced I suspect you could remove the tumor from the uterus leaving the organ behind. That may or may not cause a problem for the baby in the rest of the uterus. If the cancer was more advanced and had metastercized then removing the uterus would have no real impact as the cancer had spread throughout her body. (Although it may slow the cancer down, I'm not an oncologist).

On a related note I would think most non-surgical treatments would suffer from the same issue. Chemotherapy hits dividing cells hard. I would suspect oncologists would not want to put a pregnant woman on chemo. Likewise radiation is also an obvious issue when you're dealing with a pregnant woman with cancer in her uterus.

My guess is that this is it from another source: http://www.catholiceducation.org/articles/philosophy/ph0040.htm

See the link to the Catholic Bioethics center which is a breath of fresh air in the face of defenders of the hospital's actions in putting out some real howlers about double-effect. We kept hearing from one mouth that no one (not even the bishop apparently) knew the specific details of the case, so bad bishop! Out of the other mouth we heard that the hospital certainly followed Catholic guidelines even after claiming no one knew the details, so once again, bad bishop!

For those of us in the dark about the details, it is a simple matter of looking at the history. This hospital's previous creepy involvements with abortion demonstrate that they either believe that there are the Three Exceptions (rape/incest/life-of-the-mother), or that they know there are not Three Exceptions, but want there to be and are using hard cases to try to force the issue.

For once, I think Boonton may be right. On the empirical issue, my guess is that cancer of the uterus doesn't actually present a good, clean case of "If you act immediately and cause the child's death, you'll save the mother's life, but if not, not." If the cancer is that advanced, removing the uterus probably _won't_ save the mother's life. If the cancer isn't that advanced, removing the uterus can wait a coupla months. The reason cancer of the uterus is used as an example is because it can be made to sound like it fits all the requirements of double effect: "Look ma, no abortion."

In my opinion, the reason it's ridiculous is because by cutting out the uterus you _are_ removing the child. He just happens to be "in a bag," as it were. If you threw a child out of an airplane, you'd still be throwing him out of an airplane even if he was encased in a bag that also contained a ticking bomb. It would be sheer sophistry to say, "I didn't kill the child. I threw a bag containing a bomb out of the airplane. Hence my act itself was good."

What's done _far_ more often in any event is just a plain, garden-variety abortion so that they can get cracking on the chemotherapy and/or radiation, which of course no doctor will do on a pregnant woman for reasons of liability.

Lydia-
your example doesn't match what was actually said; Boonton assumes that the cancer has metastasized, which is an extra step. (Perhaps they've advanced in the last few years, but last I knew it was far from a yes/no question-- you've got "clump of cancerous cells" and "area is infested with cancerous cells" but you don't know until you find the other cancers-- I seem to remember a radiation based treatment with dye that has a good chance of finding it?)

Most glaringly, there is no denial that one's acts kill the child. Full stop. It's a sad side effect, not the intention, not a good thing.

A closer one would be in a ship with a hole in the side shutting the water-tight doors, even when they know there are people in the flooded area. This comes up so often in movies because it is a similar dilemma -- do you think Spock wanted to kill himself?

It's not assured to save the ship and those outside of the area, but failing to do it is assured to sink the ship.

Nobody's arguing that simple abortion is far, far more common than any case where one can make an argument for moral action. How often it happens isn't really relevant.

Rather wish he'd stuck to the usual ectopic pregnancy example, it's harder to think up a hopeful situation for.

I used the word "good" because of the quoted passage:

1) The act itself is good; it is the removal of a diseased organ.

As for denying or acknowledging that the act kills the child, it's a case of well, sorta. The denial is that this is a _direct_ killing. In other words, it's acknowledged that the child will die but only indirectly. I'm afraid that this really is problematic with respect to throwing the baby in the bag out of the plane.

I fixed the link. Don't know what I did wrong the first time.

So you're arguing that it's not good to remove a diseased organ? That's the format of the reasoning; you HAVE to break things down step-by-step, and you can't look further than the most simple step. It's like those mathematical proofs from math class.

From the quote:
the unborn child will die as a result of the removal of the diseased organ

It's listed as a bad that has to be strictly a side-effect, just as the kid's death when the woman died would be.

It is different to shut the watertight doors than to hold someone under so they drown. Both result in a drowned person, but one you take a good action-- "take action to keep the ship from sinking"-- that has a bad secondary result-- "anyone on the other side dies."

The nylon bag example is really weak because nylon bags are weak--I've torn them with my bare hands, and I'm not strong nor was it even on purpose. That's why I go with the watertight door example, since it's a situation where the choice is between "everyone dies," and "some die," as a result of a morally neutral or good action.

As for denying or acknowledging that the act kills the child, it's a case of well, sorta. The denial is that this is a _direct_ killing. In other words, it's acknowledged that the child will die but only indirectly. I'm afraid that this really is problematic with respect to throwing the baby in the bag out of the plane.

But that is the nature of the double-effect scenarios, since indirection is always baked in. I think the short answer is that Weigel is correct, and correctly applying the double-effect principle.

This does not mean I'd advise the mother to do this, nor that I would put a lot of trust in medical science to determine if it was really necessary. There are way too many unknowns in all these types of scenarios. I'd guess most people would rather risk death in these circumstances than face the fact that they might live not knowing whether it was necessary or not. Or worse, die soon anyway knowing that the act that killed the baby didn't help anyway. I think either scenario is at least as likely as that the woman is cured and lives a decent life afterwards, no matter what the doctor thinks.

So in personal moral terms, I'm doubtful that a virtuous person would perform the "good act." I think the odds are that the baby dies for a supposed good of the mother, which is not as likely to happen as her doctor probably thinks. But in legal terms, it is permissible. As public policy, we simply can't require people to give their lives for others, and without a penalty you have no public policy on the matter. If the mother feels she must abort the baby to live she is free to do so, whether we agree or even respect her for doing so. Even though the "health of the mother" is used shamelessly and duplicitously to advance the pro-abort cause for any and all reasons, it is a valid public-policy exception that must be supported, however rare it really is.

If the mother feels she must abort the baby to live she is free to do so, whether we agree or even respect her for doing so.

Actually, Mark, Weigel's position would be that the term "abort" should not be used in this situation. The position he's defending is, literally, that this is not an abortion. Does that seem correct to you?

The question of penalty is actually a separate one. People talk (rightly) about morality all the time even when there is no penalty.

Actually, Mark, Weigel's position would be that the term "abort" should not be used in this situation. The position he's defending is, literally, that this is not an abortion. Does that seem correct to you?

The question of penalty is actually a separate one. People talk (rightly) about morality all the time even when there is no penalty.

In the case Wiegel is speaking of, I would not use the term "abort." I was speaking more broadly and considering other cases. I was attempting to address both the moral aspects and the legal, but distinguish between them. Penalties would only apply to the latter.

I am strongly inclined to say that in the case Weigel is discussing you are directly killing the child, if we assume a child young enough that nothing whatsoever can be done for him and that, knowing that, you make no attempt to do anything for him. If we're talking about a child even plausibly viable, if the child is immediately removed and everything done to save him, that's a whole different ballgame.

I am strongly inclined to say that in the case Weigel is discussing you are directly killing the child, if we assume a child young enough that nothing whatsoever can be done for him and that, knowing that, you make no attempt to do anything for him. If we're talking about a child even plausibly viable, if the child is immediately removed and everything done to save him, that's a whole different ballgame.

Well I was assuming hypothetically that nothing could be done for the child. If anything could be done it would be morally impermissible not to do so and it would be another ballgame. Maybe I'm guilty of lazy reading and I've missed something. In my understanding, PDE doesn't allow us to hide behind indirection if there are any other options. I think most PDE scenarios presuppose the actors see no other options.

Mark-
you're correct.

No, Mark is not correct. Even if nothing can be done for the child, you may not directly kill him. The mother's womb is his food and water. Taking away a human being's food and water is an attempt, directly and intentionally, to kill him. Neither does PDE depend on the presupposition that "the actors see no other options." It depends on the 4 points given above, one of which is that we must not intend the foreseen evil effect, which we absolutely do intend if we take away the child's food and water.


In my understanding, PDE doesn't allow us to hide behind indirection if there are any other options.

That part is correct, but that's not what we're dealing with here.

Bill, as I said, since I'm not a doctor, I need to use hypothetical scenarios to even have an answer on this. Like Foxfier, I'd have preferred a more clear example at the least. I think we have different medical scenarios in mind. I think everyone else has a clear understanding of the medical particulars, but since I don't I shouldn't have entered this debate I guess. It's too ambiguous for me. I assume you aren't saying that removal of food and water is always a direct attempt to kill, because strictly speaking that wouldn't be true.

And oxygen. That kills the child even more quickly. No other source of oxygen. Like taking all the air out of a room the person is in and sealing it from getting any more air.

One of the things worth noticing about the uterine cancer case and which goes directly to the issue of intention is this: had one been unaware that the woman was preganant, one would have proceeded exactly as is suggested, by surgically removing the uterus. One can readily imagine a doctor making the discovery that the woman happens to be pregnant in the course of surgically treating the uterine cancer, and then hoping against hope that somehow the baby survives the whole awful procedure even though one has reasonable grounds for suspecting that this is far from likely. This would be a case where there really is no desire for the evil consequence (the death of the baby), and so hardly any intention to procure its death. One might know that something will result in a death and yet not intend at all that very consequence. Indeed, one might hope for the very opposite. This is why such a case is not a direct abortion and so possibly meets the criteria of PDE. Now this situation is very different from the Phoenix case and very different from what goes on in an ordinary abortion (if it ever can be called ordinary!). In that case a choice had to be made between saving the life of a mother by deliberatly taking the life of a child in the uterus, or by setting about saving the life of the child in the uterus and letting the mother die. Choosing to take the life of the child in that circumstance can only but be a case of direct killing.

Bill-
you're assuming it is direct killing. That's basically the very argument going on here.

That said, seeing as I was directly below Mark saying "In my understanding, PDE doesn't allow us to hide behind indirection if there are any other options," you might've considered I was directly responding to that statement.

Morally, going off of less inflammatory situations, the foreseen, indirect and lesser evil that is a side effect of an action not inherently wrong that is done to prevent a greater evil that cannot otherwise be prevented is not the same as specifically doing that evil. (Delivering the child early would be an example of otherwise preventing the mother's death.)

The watertight door example.

The standard ectopic pregnancy example.
(Really the closest to this, since in both cases they're both going to die if the area the child is implanted at isn't removed.)

Driving too fast to get your child to the hospital puts everyone you meet at risk, but if there's a good chance she'll die if she's not there quickly, a parent will take it. A less sure example, but closer to the emotional manipulation of Lydia's "nylon bag" notion. (Of course, her choice also dooms the child and everyone on the plane....)

I _completely_ disagree that driving fast to the hospital is _at all_ like throwing a baby out of an airplane in a bag! (And it could have been a canvas bag or anything. Didn't have anything to do with being nylon.) This isn't a matter of risk but of practical certainty. It would be more like knowingly and with foresight _driving over_ another child on your way to take your own child to the hospital.

Francis, of course if the doctor doesn't know the woman is pregnant, that's more like a hunting accident. But we're assuming that it's legitimate to do even if you know the woman is pregnant. I understand the point you're making--that there's this thing you're doing (taking out the diseased uterus) that isn't illegitimate in itself and can be done for purely helpful reasons, but when there's a baby inside and you know it that's gotta make a difference. If you had to saw away a beam to free somebody from a wreck, that would be fine _unless_ you happened to know that somebody else's neck was going to be sawn off along with the beam in the very process.

That is to say, _I'm_ not assuming the surgery is legitimate, but _Weigel_ is saying it's legitimate. Sorry for the misstatement.

Foxfier, unfortunately the ectopic pregnancy example is not clear enough to be an excellent example for PDE. It suffers from 2 specific issues. First, it only used to be true that doctors thought that an ectopic pregnancy meant certain death - for both - if left alone. A mother delivered a healthy baby from an ectopic pregnancy about 2 years ago. I don't know the specifics, but the FACT of the successful pregnancy has to mean something about the condition that looks to whether you have other options than surgery.

Second, because it is the baby itself that is the irregularity affecting the fallopian tube, as a result the surgery to remove the tube cannot be objectively separated from the act whose object is described as "removing the baby". One way to get at the object of the act is to ask: would the surgery be done if the baby weren't there? Obviously, for the ectopic pregnancy, the answer is no. Therefore, the baby is not incidental to the object of the act, and IMO therefore "removing the baby" is not an accidental effect of the act. Or, at least, the object is not CLEARLY independent of the fact of removing the baby. What's wrong with the tube? What's wrong is that it has a baby in it, that's bad, so removing the failed organ is caught up in the fact of the baby being present, and therefore removing the failed organ is not independent of formally choosing to "remove the baby".

With the uterine cancer, the case truly is different. Would you do the surgery to remove the uterus if the baby weren't there? Yes, certainly. Does the baby have anything to do with the failure of the organ? No, the cancer exists independently of whether there is a baby, and the organ is killing the mother independently of the presence of the baby. Is the reason you need to get the uterus out of the body connected to the fact that the woman is pregnant? No, it is not, you would need to do it even if she were not. (Assuming that chemo or radiation would not be the preferred principal treatment, which is true in SOME cases at least.) Does the death of the baby improve the odds of the mother surviving? No, not at all.

Lydia opposes this by saying that I am strongly inclined to say that in the case Weigel is discussing you are directly killing the child, if we assume a child young enough that nothing whatsoever can be done for him and that, knowing that, you make no attempt to do anything for him.

I fear that there may be 2 valid senses of "directly killing" the baby. In one, the surgeon's act is the act responsible for the baby's death. The surgeon removes the baby from its natural source of sustenance and protective environment, and also from its ONLY effective source of these. Such a removal is, in fact, "directly" killing the baby in a sense: the natural process would leave the uterus and baby in place until birth, and removing the uterus is directly responsible for killing the baby. So, yes, the surgeon causes the baby's death.

On the other hand, neither the death of the baby nor the

removal of the baby away from its only life-sustaining place is the object of the act. The surgery was designed by surgeons who figured out all the methods of dealing with a uterus with cancer, and the surgeon is using those methods because they successfully remove the cancerous uterus, not because they remove a baby. The surgery was decided upon because this method of dealing with the cancer is (given the stage of cancer, for example) the only realistic approach to saving the mother from cancer. Nothing about that decision rested on it being so because the mother was pregnant. The fact that removing the uterus means removing the baby from its life-sustaining environment is totally INDEPENDENT of the conditions by which you conclude that removing the uterus is the only way to save the mother.

Look at it from a reasonably believable future, say 50 to 150 years from now: it believable that we will have artificial wombs that will handle a baby in the first trimester. At that point, a doctor could remove a cancerous uterus knowing that there is a decent chance for a back-up source of survival for the baby. That would be great - but the intention to save the baby is distinct from the intention to save the mother. The object of the act of surgery is to save the mother by removing the organ that is killing her. The surgeon in no wise intends the death of the baby, even though he knows that without a back-up womb, the baby would die. (Or, to make the object clearer: in the early stages of artificial wombs when they are still experimental with only 1 in 5 success rate, the surgeon in no wise does the surgery intending the death of the baby even though he knows that there is a good chance that the hope-for back up might not work in this case.) Therefore, the specific object of the act of the surgeon is the removal of an organ killing the mother, and does not include anything about the baby.

Therefore, it is right to say that the surgeon is responsible for the death of the baby, but he is not blameworthy for that death because (a) the death is outside of the object of the act, and (b) the intention of the act is proportionate to the evil foreseen and caused.

While I am not a doctor, I have had to do some research on cancer. It appears to me, a layman, that surgery often is the preferred principal treatment when the cancer tumor is large but has not yet metastasized. Being large, neither chemo nor radiation necessarily are sufficient, I gather, or at least tumor removal WITH chemo is so much more successful than mere chemo as to be the overwhelming choice in certain cases. There can, it would seem, be some fairly clear cases where the honest professional judgment of the doctor is to do surgery now, within the week, or the patient will die within a few months, and if you wait until the baby is "viable" it will be too late the mother will die.

I assume you aren't saying that removal of food and water is always a direct attempt to kill, because strictly speaking that wouldn't be true.

No, I'm not saying that. But it is true for the case that Weigel gives us.

you're assuming it is direct killing. That's basically the very argument going on here.

No, Weigel's (or the NCBC's) scenario stipulates that removing the uterus will kill the baby. That's what I'm working with. Your position must be that taking away the child's food and oxygen would not be (or might not be) a direct attempt to kill it. That's the assumption that needs explaining.

I appreciate Francis' attempt, but it's hard to imagine a surgeon operating on a woman without having run diagnostic tests that would have detected the pregnancy. Well, supposing he didn't, I guess it would depend on how far into the surgery he was before he detected it. If he'd already removed so much of the uterus that the baby couldn't survive, then (assuming no incompetence) this would be, as Lydia points out, an accident, and Francis' example would fit.

But let's alter the scenario. Suppose that before surgery it is determined that the cancer has caused a crisis for the baby, that it is the cancer itself that has cut off the baby's oxygen, and that he is in fact now dying, and that it is still possible to save the mother. Would it then be permissible to remove the uterus?

Tony-
I will need to see very good medical support for the claim that 1) an ectopic pregnancy was delivered successfully, and 2) it was not a freak happenstance-- ie, the baby implanted far enough down that it could grow in the womb. We can't build morality on miracles or possibly weaseled stories.

Second, because it is the baby itself that is the irregularity affecting the fallopian tube, as a result the surgery to remove the tube cannot be objectively separated from the act whose object is described as "removing the baby".

Again, we disagree.
The baby's growth is the cause of the problem, but is not the problem-- the ruptured organ is the problem. If we could figure out a way to keep the organ from breaking and killing her, it wouldn't need to be removed. Directly killing the baby is verboten no matter what, but taking out the organ that will kill the mother, even though it results in the death of the child growing inside, is different.
That's the whole debate in a nutshell. Where the goal "remove the baby" (skipping the morality of that) the surgeon would be wrong in his actions because it is not required to remove the organ to remove the child; chemical abortion would do it.

Look, to prove this wrong, all you have to do is prove that shutting a watertight door when you know 1) someone is trapped on the other side and 2) failing to do so will sink the ship is morally the same as holding that person's head under until they drown.

Incidentally, part of the definition of being "responsible" is "able to be blamed or credited for it." Yay, limits of English. -.- I'm sure we've got a word that fits, or we could pile qualifiers to describe the situation-- such as "a good action which results in a regrettable, foreseen and unintended evil that is not disproportionate to the good"?

I can accept that what this boils down to is a talking-past situation, or an issue of definition, or somesuch-- basically means there's no way to resolve it, unless one side is willing to give up their definitions. (Since I'm going off of a long established line of moral reasoning, I know _I'm_ not going to change the definitions, it would cause too much confusion.)

The other thing about the ectopic pregnancy example is that when the tube actually ruptures, as far as I can tell this kills any living child immediately or almost immediately, yet while a ruptured ectopic pregnancy is very dangerous for the mother, it has been treated successfully and the mother saved in various cases. Therefore, keeping the mother under observation and treating her immediately for a ruptured tube or doing the surgery immediately when a heartbeat can no longer be detected by ultrasound in the fetus is indeed an option that does not result in the mother's death with anything like certainty and that does not involve the surgeons in removing a living child.

Tony, I understand what you're saying, but I think being that kind of morally certain cause of the child's death in such a direct way (it's not like you just set off a long involved chain of circumstances involving, say, the willed acts of other people) has got to be a problem. It's quite different from, say, cutting off the electricity to an enemy city where this _might_ cause the deaths of people needing electricity for some vital purpose, but where it might not because hospitals, etc., have backup generators.

I notice that there's an inclination here to speak in absolutes.....either all ectopic pregnancies are 100% fatal or they are not. In real life though, we tend to think in terms of probabilities. If I were trying to sic a rabid dog on you, you'd certainly say I was attempting to kill you. But the fact is there are a handful who have survived rabies. It's not always fatal and there's some experimental techniques that have been reported to work. Likewise even a gun shot to the head is not fatal in about 5% of cases. A random gun shot wound, no doubt, has a much higher survival rate than that (I tried to find a stat. on Google for the odds of surviving a gun shot wound but no luck). Likewise if I came at you pointing a gun I believe both the law & most moral thinking would assert you would have the right to use deadly force in terms of self defense (and don't talk about the baby being innocent, self defense is only a right to protect yourself, not pass judgement on the person who is the threat. The man coming at you with a gun might be suffering from horrible delusions and have no moral responsibility for his actions)

From wikipedia, the survival rate of uterine cancer starts out relatively high at over 90% for stage I but in later stages drops to around 15% with the most dramatic drop happening between stage III and IV when the cancer starts invading the bowels. Yes cases of people 'beating the odds' do exist but shouldn't really count. The odds of surviving a gun shot are almost certainly much larger than 15% yet no one says shooting someone isn't attempted murder. Likewise it's also possible simply bumping into an otherwise healthy person might set off a cascade of things resulting in the person dropping dead from a heart attack in front of you. This is normally not considered murder even though there's a very small chance it may happen. Football is not a game of repeated murder attempts.

For purposes of evaluating the case, the question should not be is it possible in theory to get the best of both worlds, mother and child saved, and treat that as a normal possible outcome even if it requires the medical equilivant of winning the lottery. The question then should be is the forecasted outcome of death for the mother if the uterus is not removed reasonable, not absolutly certain.

The next question is chemo and radiation. What would be the morality of giving those? Again odds are a factor here, no one can probably say what would happen to the child if the mother started getting radiation and chemo. But suppose she opted for that. One way of looking at it is both are 'fighting the cancer' and chemo and radiation are just inherently risky. But from the analysis presented here I'd suspect you'd have to say since the child doesn't have cancer he doesn't benefit directly from the chemo or radiation (assume the cancer is not so aggressive that it will kill the mother before the baby can be born). Since he has no direct benefit but a real direct risk the mother should not be allowed to use chemo and radiation.

I'll preface my comments by admitting that I haven't read all 27 preceding ones. With that caveat:

1) People say "advanced" not because that in and of itself carries some moral weight, but just to show that they're talking about an acute case, rather than giving a categorical license that comes into effect any time there is a given diagnosis.

2) The key distinction between these two cases, the reason that double-effect permits the hysterectomy but prohibits the Phoenix abortion, is that only one involves a direct, intentional killing. If Dr. A. performs a hysterectomy on a pregnant woman, he intends to remove the uterus from the woman's body. He knows that any child being carried in the uterus will die. But knowledge and intention are different thing: you don't need the Model Penal Code to tell you that. However, if Dr. A dismembers or scalds to death the child being carried in the woman's womb and then removes her uterus (or not), he intends to kill the child. He may have other goals as well, but the nature of the act performed is such that it can only be undertaken if the performing individual has the intention of killing the child. That is not merely a known consequence of the act, but the very nature and end of the act itself. The intentional killing of the innocent, of course, violates the principles of double effect in numerous respects.

3) Incidentally, as an aside, it seems relatively clear that the same analysis prohibits the destruction of an ectopic embryo by lasers or other non-invasive means. It would seem that the only appropriate method would be the more traditional method of excising the relevant portion of the fallopian tube. But Charlie Rice never seemed to be sure when he talked about it, so maybe I shouldn't be.

Titus,

It seems like a classic distinction without a difference. I'm don't know the procedures for a hysterectomy but what if the doctor is required to remove the organ by cutting it half first. Then it would seem he is likewise required to cut the child in half. But you're saying if he cuts the child in half first, say to make the uterus small thereby allowing it to be removed through a smaller opening in the body, that makes a big difference.

Boonton, since everybody else in the discussion so far on all sides thinks the fact that the child is innocent to be relevant, and since you dismiss this consideration out of hand and treat the child as a non-innocent attacker, I cannot imagine why you would expect there to be any profitable dialogue here. It's pretty obvious that Bill didn't pose the question to people who regard innocence as irrelevant.

No, Mark is not correct. Even if nothing can be done for the child, you may not directly kill him. The mother's womb is his food and water. Taking away a human being's food and water is an attempt, directly and intentionally, to kill him.

Precisely. People get caught up in the difference between what those doing the act may intend and what the act necessarily entails.

The only grey area I would see here is if one could show that the child itself has cancer as well. Emphasis on grey area, not "exception."

People get caught up in the difference between what those doing the act may intend and what the act necessarily entails.

Exactly. When Titus's says that Dr. A "intends to remove the uterus from the woman's body," knowing "that any child being carried in the uterus will die" and yet not intending the child's death, Dr. A is attempting to separate his intention from his (in Lydia's phrase) "morally certain" knowledge that he is in fact causing the child's death. This is sometimes known as wishful thinking.

When Titus's says that Dr. A "intends to remove the uterus from the woman's body," knowing "that any child being carried in the uterus will die" and yet not intending the child's death, Dr. A is attempting to separate his intention from his (in Lydia's phrase) "morally certain" knowledge that he is in fact causing the child's death. This is sometimes known as wishful thinking.

Or he's speaking in an entirely different language than you are thinking.

Going back, again, to the sinking ship example-
1)It is never OK to kill an innocent person.
1-a) Even if you are really sure they're going to die anyways-- it's not your place, and it sins against hope.
2) There is a responsibility to preserve human life.
3) You cannot do evil so that good can come of it.

If you agree with the above, then either the directness of the action matters-- abortion vs hysterectomy, holding someone under vs closing the watertight door-- or you must allow a ship to sink if you believe there is someone on the other side of the door.

To steal from a recent movie- !!!Batman spoilers!!!
you think that the big scary guy who threw their button out the window was wrong, because his action doomed the innocent cops on board.

Although, honestly, you might be going on a case-by-case morality-- which I do not agree with at all, but is an option. (gotta avoid forced choices)

Foxfier, you make an interesting point: that the use of the fallopian tube pregnancy for PDE is rooted in an example where the fallopian tube is now rupturing. I say that this is interesting, because I have read at least 4 different authors pose this example, and I don't recall them making the specific example rest on the actual rupture occurring. I wonder why.

But in any case, there remain problems: if you have a rupturing heart, you don't remove the heart. If you have a rupturing aorta you don't remove the aorta - you try to repair the rupture. For certain other organs like the spleen or appendix, if it ruptures you take it out because you know the person has a darn good chance of surviving without it. Can I ask: if a surgeon knows that the fallopian tube is rupturing because there is a baby in it, would he not be obliged to try a procedure that attempts to save the baby (even if unsuccessful) rather than simply remove the tube? If a person's life rests on the fallopian tube remaining, then you don't simply remove the fallopian tube because it's rupturing. This would tie in with what someone said above: that there is a procedure to attempt to move the baby with placenta to the uterus, where it was supposed to be all along. It could be said, then, that the decision to simply remove the tube rests on a couple of thoughts: that repairing the rupture won't stick, the tube will simply rupture again because the baby remains there (it is, after all, the remaining presence of the baby that is part of the problem), and that nothing you attempt is especially likely to save the baby anyway, once the tube is ruptured. But that not attempting the procedure to re-implant the baby in its proper location is, in essence, to decide to save the mother by killing the baby because the baby itself is what prevents the surgeon from attempting a potentially saving procedure of repairing the tube.

Just to be clear, Foxfier, you're saying that when Dr. A performs the hysterectomy, knowing full well and with absolute certainty that removing the child's food and oxygen by his own hand will kill that child, that he is not directly the cause of this death nor intending such a result?

I'd like to apologize for not having seen any of the Batman movies, but so far no regrets.

Dr. A is attempting to separate his intention from his (in Lydia's phrase) "morally certain" knowledge that he is in fact causing the child's death.

I don't think moral certainty is even necessary. There are plenty of cases where you can show a sufficiently callous attitude toward the likelihood of harm to merit being called a murderer. This is why we have the concept of "felony murder." It may not have been a robber's intent to kill his victim, but the moment he started waiving a loaded gun in the guy's face he made it obvious to all and sundry that the man's life was of less importance than his wallet.

Intent only matters when one can claim that the action was not only not intended, but the action they intended and tried was sufficiently different to make the evil outcome accidental.

Tony -
you only try to repair what can be fixed.
Can I ask: if a surgeon knows that the fallopian tube is rupturing because there is a baby in it, would he not be obliged to try a procedure that attempts to save the baby (even if unsuccessful) rather than simply remove the tube?

An express part of the double effect is that there can't be any other reasonable option. If there's something they can try instead of removing the tube, it's not a matter of double-effect anymore.

Bill-
Just to be clear, Foxfier, you're saying that when Dr. A performs the hysterectomy, knowing full well and with absolute certainty that removing the child's food and oxygen by his own hand will kill that child, that he is not directly the cause of this death nor intending such a result?

No more than a sailor who shuts a watertight door to save everyone else on the ship is directly and willfully killing those on the other side. No more than Spock was committing suicide when he stayed in a place he knew was dangerous to save everyone else.

You're probably not missing too much-- short version, there's two ferries, they've been wired to explode, and there's a button on each ship. One is a prison barge, one is full of evacuating school children and their parents. The bad guy comes over the 1MC and explains that they've got an hour to push the button and blow up the other ship, or both will explode. Much milking of drama, this guy demands the button, saying he'll do what should have been done ten minutes ago, and throws it out the window so nobody can push it and kill the kids. By doing so, he dooms everyone on the ship.

Mike T -
you're forgetting that the action has to be either good or neutral in itself-- armed robbery is neither. (Armed robbery also only works because you are explicitly threatening: give me your stuff or I will use this weapon on you; a defense that you were lying is rather weak.)

Lydia,

I'd appreciate it if you'd respond to my comments with honesty. I specifically pointed out that an argument from self-defense does NOT mandate that a person deem the victim to be 'non-innocent'. The example I cited (a madman with a gun) was to demonstrate that you cannot really make a judgment about the innocence of the person who may threaten you life in some circumstances. The lunatic coming at you with the knife may be so deranged and ill tha the bears no moral accountability for his actions. If so he would be innocenct but the law still recognizes a right for you to defend yourself.


Tony,

I think you're short circuiting the issue by asking the surgeon to 'try to save the baby'. If this was possible that might be one thing but the surgeon is only 'in the body' for a limited period of time and only has so many things he can do. If no known technique exists then what are you really asking him to do besides removing the baby, thereby causing its death, but saying he 'tried' to save it...which he really can't if there's no known procedure that could accomplish such a thing.

What if we gave the woman chemotherapy or radiation knowing that it would almost certainly result in the baby's death (chemo, remember, targets cells that are dividing) but told the oncologist to 'try' to target the radiation away from the baby or to 'try' to administer chemo that doesn't cross the umberical cord?

Boonton, I can't for the life of me imagine why you think I'm not using "honesty." The point is _precisely_ that you're saying that we should regard innocence and guilt as _irrelevant_ and that it's legitimate to think of the child as an aggressor. Since nobody else agrees with that premise, since all the rest of us assume that we _can_ know that the child is innocent and that this _is_ relevant--you're just not joining the conversation anybody else is carrying on.

You're forgetting that the action has to be either good or neutral in itself-- armed robbery is neither. (Armed robbery also only works because you are explicitly threatening: give me your stuff or I will use this weapon on you; a defense that you were lying is rather weak.)

In the case of the doctor doing the hysterectomy, the doctor cannot perform the action without killing someone. That fact cannot be divorced from the act. Therefore the medical operation is not good or neutral.

No more than a sailor who shuts a watertight door to save everyone else on the ship is directly and willfully killing those on the other side. No more than Spock was committing suicide when he stayed in a place he knew was dangerous to save everyone else.

Ultimately, God will judge the hearts of the sailor and the doctor. The sailor would have mitigating factors on his side such as self-defense and the fact that he was facing an immediate life and death situation for everyone else. The immediacy mitigating factor wouldn't exist with the cancer. Furthermore, today it is likely that the baby could be prematurely delivered so that it would have a fighting chance and the mother could get cancer treatment.

It might be plausible to argue a mitigating factor if the baby were also suffering from cancer, at least a stage that is almost certainly to be incurable. If someone is actually dying, cannot be saved without the almost certain death of someone who is not dying and your actions don't necessarily hasten their death that would introduce a lot of new variables to consider as mitigating circumstances.

Intent only matters when one can claim that the action was not only not intended, but the action they intended and tried was sufficiently different to make the evil outcome accidental.

Right, intention matters, but is not the only thing that matters. A morally good human act must have a good (or at least neutral) object as well as a good intention. Playing soccer has a neutral object, but the act can be vitiated by having a bad intention.

The trouble, of course, is that identifying the object of the act is incredibly problematic. The intention may stand at one or more removes from the actual act itself, but the object cannot. A surgeon may intend to save the mother (or not - if he is a sadist) by removing an organ, but either way the object of the act is found in the actual removal and its concomitant realities: that it is in a state of disorder and causing death is just one such concomitant reality. That the removal of the organ also means the removal of the baby from its source of life is another reality. Saying that the object of the act refers ONLY to the removal of the organ and NOT to the removal of the baby is the locus of the unsettled debate.

Most of us agree, I think, that it is not necessary to attribute to the doctor an evil intention "I want to make sure the baby dies." If the object of the act formally includes "that the baby be rendered into a condition it cannot possibly survive in" that object would be an evil object and the act would be evil. The question then is MUST the object of the act formally include such a specification?

I think, with Foxfier, that it is very telling to compare this to the bulkhead doors in a ship that will sink if the doors are left open. It seems difficult to ascribe to the officer who closes the doors even though he knows there are people on the other side, as a formal object, that "the people be left with no way to survive." That just doesn't seem to be a necessary describing aspect of the moral act he is making. If he were not a ship's officer, but a passenger without knowledge of the ship, he might not know whether there might be some other way out of the chamber they are in, that might possibly be available (or might not be, with the water coming in) - the fact that he doesn't know would not render his act to close the door tantamount to murder like a robber waving a gun around during robbery without knowing if it is loaded (and eventually killing someone "accidentally"). The passenger's object does not include "close off all possible routes of escape for the people on the other side" but rather "close off this known avenue for water to get into the rest of the ship", and he simply does not have any mental determination whether that does or does not also close off the only possible escape route for the people. Without knowing and without making a determination about whether there is or might be some other avenue of escape, his choice to close the doors against the water is indeed an act to close the doors against the people escaping through these doors, but the moral choice in his will does not formally include "close off all possible avenues of escape" even if it turns out later that these doors were, in fact, the only possible avenue of escape for those trapped people.

I have trouble seeing why this passenger, who doesn't know the ship, would have a definitively different object of the act in choosing to close the doors on the trapped people than would the ship's officer who DOES know there is no other way out. I think that the act in the will of the passenger and in the officer are essentially the same: to save the ship and its other passengers (that's the intention) by closing off the doors against the invading water (that's the object of the act). I am saying that the passenger who closes the doors is not doing an act that harbors a moral defect by not first finding out whether there is some other avenue of escape (we are assuming that mere seconds are critical here - a few seconds more and it will no longer even be possible to close the bulkhead doors). There is no moral defect in acting without knowing whether there is some other avenue of escape for the trapped people, because the object of his act is already specified in knowing that closing the doors right now is the only reasonable way to save the ship. And if it is specified without respect to knowledge about other avenues for escape, then it is so for the officer who knows there isn't any.

In the case of the doctor doing the hysterectomy, the doctor cannot perform the action without killing someone. That fact cannot be divorced from the act. Therefore the medical operation is not good or neutral.

I think you just simply are not getting the point, Mike T.

One. Step. At. A. Time.
It's annoying, same as math proofs, but if you're going to respond to a theory, you have to respond to the theory.

If you don't go one step at a time, you allow equal room to do a little evil that good may come of it, or you're going on a case-by-case form of morality.

The immediacy mitigating factor wouldn't exist with the cancer.

So it's OK to cause an indirect death if you've got to hurry? (I disagree that there's no way cancer would need immediate response.)

Furthermore, today it is likely that the baby could be prematurely delivered so that it would have a fighting chance and the mother could get cancer treatment.

For crying out loud, IF THE CHILD CAN BE DELIVERED EARLY THEN IT IS NOT THE SITUATION WE'RE TALKING ABOUT!

If there is any other reasonable option then the principle of double effect doesn't apply.
I know this has been beaten to death further up the conversation.

If the cancer is at a stage where you can wait for the kid to have a good chance to survive, it's not a DE situation; if the kid is already old enough to be delivered early, it's not a DE situation; if there's other reasonable medical options, it's not a DE situation; if the doctor's goal is 'treating' the child's cancer by killing him or her, it's not a DE situation; if the goal is a dead kid, it's not a DE situation.

If someone is actually dying, cannot be saved without the almost certain death of someone who is not dying and your actions don't necessarily hasten their death that would introduce a lot of new variables to consider as mitigating circumstances.

So... kid is going to die because his mother will die, not relevant, the surgery that will indirectly kill the kid is a direct killing.
Kid is sick, maybe it's OK to directly kill the kid?
I don't think you really mean that, do you?

For crying out loud, IF THE CHILD CAN BE DELIVERED EARLY THEN IT IS NOT THE SITUATION WE'RE TALKING ABOUT!

If there is any other reasonable option then the principle of double effect doesn't apply.
I know this has been beaten to death further up the conversation.

If the cancer is at a stage where you can wait for the kid to have a good chance to survive, it's not a DE situation; if the kid is already old enough to be delivered early, it's not a DE situation; if there's other reasonable medical options, it's not a DE situation; if the doctor's goal is 'treating' the child's cancer by killing him or her, it's not a DE situation; if the goal is a dead kid, it's not a DE situation.

Foxfier: I feel your pain. I checked out of this debate a long time ago as too ambiguous to be fruitful. PDE cases are normally done as though experiments for a reason, and to make any progress we'd need a clear set of hypothetical points specified to work with. Even the linked article is a tossed off affair referring to another one not linked. But it seems to me some here may not accept PDE to begin the way the term "direct killing" is thrown about. What about a pilot ordered to shoot down a 747 full of passengers that was hijacked and headed to downtown NY to kill thousands?

I think you may be right about PDE, Mark. I myself am inclined to use it only in cases where one of the following obtains:

The death of the innocent person will be carried out by some deliberate act of someone else (e.g., "If you do X, an evil man will kill n innocent people"),

or

The death of the innocent person is merely a risk of the act, not highly probable (e.g., driving on the highway),

or

The act is an attempt to save the _very same_ innocent person whose death may be caused by it (e.g., Hail Mary passes in brain surgery).

Right now, I'm not thinking of any others.

I'm beginning to realize that these aren't the situations in which other people want to use the concept of PDE.

Lydia, I'm not sure if I entirely understand. If you don't use PDE, what do you use in cases involving highly probable harm? Wouldn't adhering to these force you to pacifism? How would you justify acting vigorously in the world in any but personal situations (in groups there is far less control.)

I'm real hawkish on bombing the tar out of unquestionably military targets and on things like fighting the enemy on the ground.

Mark, I'm also willing to regard people as legitimate targets even if they aren't officially soldiers, so long as they are "old enough" and are deliberately helping the war effort of an enemy--hence, the office worker at the nuclear bomb plant, Jim the Ideologue Liberal Journalist who puts himself on the roof of a building among terrorists as a human shield for the terrorists, etc.

Lydia, even unquestionably military targets just about always have civilians in them: garbage men, maids, mail men, electricians, etc. Like Mark, I had been wondering how to reconcile bombing with the really sparse, limited sort of PDE that you propose. I remember Zippy a year or two ago arguing that you can never bomb a place if you know there are civilians present. I don't believe that "you know civilians are present" can be morally distinguished from "there are very probably some civilians present" for these purposes, and the latter is true ALWAYS for any kind of bomb dropped by air, and often for any kind of artillery, or any really large explosive being used in war. You have basically taken off the table pursuing modern war altogether. Even "on the ground" methods tend to be messy: you cannot always limit your fire to combatants, if you want to survive more than 20 seconds, because the effort and time it takes to distinguish combatants from non-combatants and use only such limited type of firepower that won't reach too far (no rocket propelled grenades) is too much. You cannot expect ground forces to apply the same restraint as police do in a conflict - war is not police action writ large.

As with all the other moral debates that involve the issue of an act whose character is, or might be, evil of its own nature, nobody seems to be willing to agree on what constitutes the internal nature of the act, as opposed to an external circumstance that modifies conditions but not the nature of the act itself.

Tony, see my comment immediately previous to yours. "Civilian" isn't necessarily the most relevant category. On his personal blog as I recall Zippy took the situation that it may be just fine to consider the janitor at the military target to be military targets; it's the four-year-old girl you have to worry about, but fortunately, they're not usually wandering around munitions plants.

it's the four-year-old girl you have to worry about, but fortunately, they're not usually wandering around munitions plants.

For any sizable facility, there almost always ARE people visiting who are not military targets in any way: the general's daughter on base, for example. You get it large enough with enough people there, then SOMEONE is going to be extraneous as military target.

Going back to history, when you had individual cities fighting to survive an onslaught, the attackers could never totally distinguish between combatants and the totally "innocent" who just happened to be in the wrong place at the wrong time: the teen who looked 16 but is only 13, the adult who was carrying water - was that water for the troops on the wall, or water for his kids? War on the ground was always messy. Add in catapults, and it becomes messier still - you can never be even sort of sure that when you knock the tower over, you won't get the innocents. (Same with taking out the munitions plant - you cannot tell how much of an explosion it will cause, and there is always a decent chance a ton of bricks will land 1/2 mile away on some poor sod.)

The clear demarcation between official combatants and non-combatants is something that developed over time, with a civilian militia being a middle stepping-stone to the modern all-professional army. Ancient Greeks defending Ionian cities from the Medes didn't leave the fighting to the professionals, because that was a good way for a "civilian" to wind up abused and then dead, instead of just dead. That went for the teen aged 14 as well as the 30 year old women with kids. But it surely wasn't immoral to fight a war back then.

I'd bomb the munitions factory at 3 a.m. I figure anyone old enough to know how to think clearly is responsible not to be there, and those not old enough to think clearly are unlikely to be there.

In general, I think the problems arise when you know not merely that "there may be someone" but that there _really is_ someone, and that "someone" cannot be held responsible in any way, shape, or form for being where he is or for having anything to do with the war effort.

the problems arise when you know not merely that "there may be someone" but that there _really is_ someone, and that "someone" cannot be held responsible in any way, shape, or form for being where he is or for having anything to do with the war effort.

Why does it matter whether the "someone" is someone you know cannot be responsible for the war effort (which KNOWING can only be about children, and pretty young ones at that), or is instead a "someone" for whom you do not know whether they are involved with the war effort or not? In general, you aren't supposed to do something like kill an innocent person, and consequently you aren't supposed to kill a person who _might_ be innocent but you just don't know. In standard civilian life isn't moral to say "I don't know if you are innocent, so you don't come under the general protection of innocents." It's the other way around.

Personally, I think that war is different because it involves another principle altogether, but it does still involve PDE decisions. And most of the warfare that has ever been fought (whether with spears or with guns) has involved the need to either risk killing possible non-combatants or hang it up and surrender because there is no way you can succeed. You could never know for sure whether the guy (or gal, in some places) facing you has a weapon for reasons of personal defense because they happen to be in the wrong place at the wrong time and you are a threat (think farmer in West Virginia during Civil War defending his property and home from marauding bands of soldiers, of either side), or for the "war effort" like the "home guard" old fogies age 70 who patrolled the shore in WWII Britain.

If PDE strictly limits your options and only applies to the type you suggested at 3:43, then virtually all war is out.

In standard civilian life isn't moral to say "I don't know if you are innocent, so you don't come under the general protection of innocents." It's the other way around.

Because in standard civilian life we aren't shooting at or blowing up anybody or anything. I think reasonable precautions need to be taken to aim for military targets when there are not going to be children there, or to fight surgically, and that those who are formally civilians during time of war and are capable of ordering their own lives need to take responsibility for where they are and what they are doing vis a vis military targets.

Because in standard civilian life we aren't shooting at or blowing up anybody or anything. I think reasonable precautions need to be taken to aim for military targets when there are not going to be children there, or to fight surgically, and that those who are formally civilians during time of war and are capable of ordering their own lives need to take responsibility for where they are and what they are doing vis a vis military targets.

I agree that all reasonable precautions ought to be taken, and I'm quite proud of the fact that our nation has invested lots of treasure and talent to produce smart weapons that are highly discriminatory. It is revolutionary. I'm also impressed that we and the Israelis take casualties when we don't have to ensure fewer civilians are killed, though I'm not sure we're obligated to do it.

But were this technology not available, or if we simply consider that it only minimizes civilian casualties, it doesn't change anything morally. If we were a poor nation and someone else had smart weapons I wouldn't argue that we shouldn't fight wars for the right causes unless we could get them.

The problem with all this war ethics reasoning is that it tends to focus on the negative. Don't do this, don't do that unless you think it through for an extended period of time. Reality does not always permit such classroom style armchair generalling. It quickly becomes unrealistic and romantic notions take over. Who ever said there would be a world where children don't die in war? In many armies and terrorist organizations of the world, children are the soldiers.

What is scary to me is that we have a professional warrior class who we've become entirely disconnected with. We leave them to do what we condemn in grad school seminars, but we know they must do it for our good. Like people that eat fish but couldn't bring themselves to kill a fish, it is a cognitive dissonance that isn't at all healthy. There are such things as martial virtues, and we're losing respect and understanding of them.

I actually consider myself very much on-board with martial virtues. I just don't think they apply to deliberately shooting down airliners full of innocent victims of hijackers. Bombing a munitions plant that might have a janitor in it, no problem. And no smart weapon required.

I actually consider myself very much on-board with martial virtues. I just don't think they apply to deliberately shooting down airliners full of innocent victims of hijackers.

Cool. And you know I think the shooting down of a hijacked plane is quite the moral dilemma. It isn't clear to me a president would actually give the order, or a pilot obey it. I think you'd have to know that the hijackers had a large and clear target and a very high degree of confidence that they would hit it. A stadium of people would probably do it. Downtown NY might, but it isn't as clear. No one could be sure that as much damage or loss of life would occur as actually did.

This is where it simply isn't true that some claim people like me who defend waterboarding in the few limited circumstances where it was used don't see any limits and the ends justifies the means. It's a slander. At some point you have to ask yourself about the sovereingty of God. Maybe you are playing God. At some point you have to wonder if it appears that some catastrophic event will happen if you don't act, that this is so because a whole set of moral failures didn't lead to that point, and in those failures the die was cast. There are definitely things we shouldn't do under any circumstances, though I'm not saying shooting down an airliner is necessarily one of them. But I think it is an open question in many hypothetical circumstances.

Foxfier, my question required only a "yes" or "no" answer. And "yes", if shutting the watertight door is a death sentence for those behind it, then I think it's wrong to murder people to save other people.

I understand your position. There are two effects of your act: one is good because it will, or might, save the mother; the other bad because it will, certainly, kill the child. The difference twixt you and me is that you get to pretend that one of those effects doesn't matter, and I don't.

And you know I think the shooting down of a hijacked plane is quite the moral dilemma. It isn't clear to me a president would actually give the order...

Vice-President Cheney gave the order to shoot down Flight 93.

Bill-
Thank you for someone FINALLY answering.

Foxfier, my question required only a "yes" or "no" answer. And "yes", if shutting the watertight door is a death sentence for those behind it, then I think it's wrong to murder people to save other people.

Seeing as you clearly use the word "murder" much differently than I do, it required more than a yes or no answer to be accurate. It may have been more useful for your argument, but it wouldn't offer much information.

The difference twixt you and me is that you get to pretend that one of those effects doesn't matter, and I don't.

You clearly don't understand what I'm saying as much as you believe you do, but since you also misstate the situation that's been pounded on for several pages now, it's clear you're not going to.

From your answer, it's clear enough-- if it's a life-or-death choice, you'll choose death for everyone.

Please, never be on the same ship as I am, or stay near the deck if you are; your beliefs are deathly dangerous to everyone on board.

So, one more time: when Dr. A removes the uterus and cuts the child off from his source of food and oxygen, thus killing him, you are saying that he is not murdering the child? Yes or no, please.

Seeing as you clearly use the word "murder" much differently than I do...

This is true. When I do something to an innocent person, or to the environment on which he absolutely depends for survival, such that this something will result in his death, I don't feel entitled to make up a word at my convenience to describe the deed when only one word will do.

You clearly don't understand what I'm saying as much as you believe you do...

I understand enough to know that you're a consequentialist.

Vice-President Cheney gave the order to shoot down Flight 93.

I know. What I'm saying is that I can see a great many circumstances where a pilot might well not carry it out. Giving an order is one thing, carrying it out another. I suspect that knowing the twin towers had been hit and many had died and the capital was next would have been sufficient, but those are very extreme circumstances. I'm guessing few would carry it out merely on the trust normally relied on when following orders. On 9/11 that trust probably wasn't needed. Either way, you're looking at a hellish life afterwards. Hellish. My guess is you'd have to go into the Federal Witness Protection program and start a new identity at the least.

if shutting the watertight door is a death sentence for those behind it, then I think it's wrong to murder people to save other people.

Bill, I really think you should have said that you don't believe PDE is a valid ethical principle at the outset. The way you stated it at the outset it sounded as if you did. But you clearly don't.

Murder is a legal term for unjustified killing, the justificatory condition obviously defined by law. Are you telling me you think a jury is going to convict a person of murder if he acts so that one person dies and in so doing saves others? What legal grounds would there be to do so?

The difference twixt you and me is that you get to pretend that one of those effects doesn't matter, and I don't.

I think the difference is you aren't considering scenarios where alternatives are bad and worse. A good is relative in the sense used for the four conditions. I already stated my deep skepticism of real circumstances where I'd actually countenance approving of removing a womb of a pregnant mother. So I have in mind mostly theoretic possibilities, or so I suppose, since I have little medical knowledge. But if PDE is a valid principle, the nature of it makes it valid whenever the conditions are satisfied.

I understand enough to know that you're a consequentialist.

Bill, this is absurd. Considering consequences does not make one a consequentialist.

I know. What I'm saying is that I can see a great many circumstances where a pilot might well not carry it out.

What you actually said was that "It isn't clear to me a president would actually give the order, or a pilot obey it." So by appearance it seemed that you did not know. I only supplied the information because I thought you'd be interested.

Bill, I really think you should have said that you don't believe PDE is a valid ethical principle at the outset.

You should have told me at the outset that if you do believe it, you don't know what it is.

Are you telling me you think a jury is going to convict a person of murder if he acts so that one person dies and in so doing saves others?

No, I'm not telling you that because it's irrelevant. Juries do what juries do.

I think the difference is you aren't considering scenarios where alternatives are bad and worse.

And what you aren't considering is that when the alternatives are bad and worse, such that anything you do would be an evil means to a good end, you have no alternatives.

...this is absurd. Considering consequences does not make one a consequentialist.

Killing the baby by removing the uterus is not "considering the consequences." It is to have already considered that the consequence of not doing it (losing the mother) is intolerable, and that therefore killing the baby by taking away its food and oxygen is either a positively good thing or a 'necessary evil' if it results in saving the mother, because you have already determined that that latter consequence is the only thing that matters.

Foxfier,

So it's OK to cause an indirect death if you've got to hurry? (I disagree that there's no way cancer would need immediate response.)

Where did I say that it's moral? I said that God would certainly be more likely to have mercy on the sailor than the doctor because the sailor would be panicking and operating under the certain knowledge that his actions will have immediate and drastic consequences. God has mercy on those who make the wrong call based on extenuating circumstances like panic and ignorance. God is not a legalistic philosopher who expects every man to analyze each action in his life according to logical proofs.

So... kid is going to die because his mother will die, not relevant, the surgery that will indirectly kill the kid is a direct killing. Kid is sick, maybe it's OK to directly kill the kid? I don't think you really mean that, do you?

To use your example. If a sailor lost his entire leg through some violent force related to the flooding and is rapidly bleeding to death in a flooding compartment, I don't think it would be murder to leave him in there because he's dying anyway. If a soldier is on the verge of death, is it murder to retreat in the face of overwhelming opposition and leave him?

Bill's case is the strongest. If your actions cause a person who was not dying to die, even "indirectly," then you are the cause of their death. It is cut and dry like that. For all of your condescension in your response to me, you failed to note the obvious difference between Spock's self-sacrifice and a sailor sacrificing the lives of others for his own life and that of the rest of the crew: any individual is morally free, under natural law, to sacrifice their own life for their fellow man's safety.

Murder is a legal term for unjustified killing, the justificatory condition obviously defined by law. Are you telling me you think a jury is going to convict a person of murder if he acts so that one person dies and in so doing saves others? What legal grounds would there be to do so?

The law is frequently an ass. The same law that lets people like Dr. Tiller operate with impunity calls a man a murderer if he catches a man raping his wife, chases him across town and beats him to death for violating his wife.

Bill's case is the strongest.

That answers that-- Bill's "case" made it clear he wasn't bothering to even understand what I was saying; come to think of it, so did your inability to remember things covered a few responses back.

Why on earth waste any more time beating my head against a wall? It's like arguing abortion with someone whose base world view is that abortion is good.

What you actually said was that "It isn't clear to me a president would actually give the order, or a pilot obey it." So by appearance it seemed that you did not know. I only supplied the information because I thought you'd be interested.

Tony: I know I erred in saying "or" instead of "and," and didn't acknowledge that. I wasn't annoyed you pointed it out.

The law is frequently an ass.

Mike: I know. But I think using terms clearly is helpful, generally speaking.

I'm out of this tawdry debate. Some here aren't even willing to distinguish metaethics from applied ethics in this confused mess. I'm not on the side of the righteously indignant because I considered theoretic possibilities. Not the right place to do that I guess.

No, I'm not telling you that because it's irrelevant. Juries do what juries do.
The law is frequently an ass
.

I know I said I'm out, but after 30 min reflection I have to comment on this glib dismissal of my comment about the law. What I was hinting at wasn't that a *given* jury might not convict someone for acting in a way that kills some one in your terms (I don't think shutting the door to save a ship of passengers if steps are exhausted to save those in a cargo hold is murder because of PDE), I was hinting that I wonder if such a case could be prosecuted, must less won. Put another way, i was wondering if such a case, has ever been prosecuted in the history of the world. I do wonder. Perhaps someone here with legal knowledge could comment. There is a difference between what is legal and moral, but surely *if* there were no legal precedent on the issue of murder, it would say something informative on the matter at hand. So in dismissing the law as relevant, I'd just like to know what you two are dismissing exactly. If it turned out there was no legal precident for this, would you two really consider it irrelevant?

kid is going to die because his mother will die, not relevant, the surgery that will indirectly kill the kid is a direct killing.

Bill, I fear that your justifiable insistence on getting the moral facts straight has led you into an unjustifiable defeat of common sense. If the act is indirectly killing the kid, then it is not a direct killing. It's just plain incoherence to say that.

But perhaps what you meant is that the killing is indirect in ONE sense, and is direct in ANOTHER sense. That would be not incoherent as such. You just didn't bother to mention or even point in the direction of any qualifiers to let us know what senses might be present.

Bill, does it matter that the mother's womb is the normal, natural "designed" place for an unborn baby, which (to this point in medical technology) is also the only place an early fetus can possibly survive? The place that nature herself with God's and the parents' action put the child? Because this womb is in a very significant sense THE natural place for the baby, taking the baby out and exposing it to an unnatural environment (sans blood, sans food, etc) is, in a sense at least to be the direct cause of the child coming into an environment that cannot sustain its life.

On the ship, though, a below-decks compartment is nothing like the "natural place" for a passenger stuck on the wrong side of the bulkhead doors. Nature didn't place him there, nature doesn't "design" the compartment for him. Furthermore, the man who is closing the doors is not the cause of the environment being unable to sustain life - nature is doing that quite effectively all by herself. The person closing the doors is just putting up an obstacle to the trapped person getting out of the environment that will soon kill him. That is NOT quite the same act as taking the baby OUT OF its already existing natural place of health and survival into an unsurvivable place.

Now, I didn't intend, in the prior paragraph, to settle whether closing the doors is moral or not, just to point out a distinction in the moral character compared to a doctor removing the uterus with baby. In order to judge the moral character of the act of closing the doors, you have to ask more than just: have I trapped someone who will die in that environment? Yes, you do have to note the answer to that question. But you have to ask MORE questions. Does the trapped person have a _right_ to get out? Yes, but not an ABSOLUTE right. Here's what I mean: the trapped person would have a right to get free if merely walking forward would accomplish it, and if he had the time, and if he didn't have some more pressing obligation, and if... See, there are lots of conditions that limit his right. He doesn't have the right to shove women and children out of the way, for example. He doesn't have the right to get free if his HIGHER obligation as captain is to go back into the water and hold something else closed for another minute while the engineer gets the backup engine engaged. His RIGHT has limits.

What Foxfier is suggesting is that one of the conditions is whether waiting until this person gets out of the compartment dooms the rest of the ship's people because it dooms the ship. It is easiest to see in the case I indicated last: the captain has to go back into where the water is coming in to slow it down, and he gives a DIRECT ORDER to his crewman to close the doors, thereby sealing his fate. The captain has no right to get to safety if the safety of the rest of the people depends on his taking on a task that puts him in immediate danger of death. Likewise, generically, a random trapped person doesn't have an OVERRIDING right to get to safety if the means of doing so puts the rest of the people at immensely greater (or certain) risk of death.

But that still leaves the question of whether another person B has the right to close the doors on the trapped person A. Here's where the distinction I made above comes in: it is one thing to actually remove a person's air, and another thing to LET something that another agent (nature) is doing take away his air. One is active, the other is passive. We made this distinction for morality quite insistently in the exact opposite direction: if a guy says "rape this innocent girl or I will shoot her", then morally we must ALLOW him to shoot her because we cannot rape her. The fact that I might be able to do something to prevent the outcome doesn't mean that I must in all events, and doesn't mean that I become the "cause" of the death. If you see two kids falling off a ladder, and you can only catch one, it isn't an immoral act for you to "fail" to catch the other or to choose one instead of the other, and you do not cause the other's slamming into the ground, nature does that all by herself. I submit that when A closes the doors, he is 'catching' many people, and also allowing nature to kill trapped B. The fact that A hasn't the capacity to 'catch' all isn't his own doing.

Closed doors don't kill people by their very nature. Those doors were closed 100 times earlier in the voyage. Saying that by closing the doors A kills B is to ignore the fact that the WATER kills B, and closing the doors is not the cause of the water being there (the hole in the hull is). If B had an absolute right to escape the compartment, then A would be in the wrong for blocking his exit, but B only has a limited right: a right contingent on the realities and all the needs of those around him. (The crew on the Titanic who made it so that women and children got the boats first blocked men from getting the boats first. But the men had no absolute right to the boats, and the crew blocking them were not the cause of the death of those men, NATURE was.)

Why on earth waste any more time beating my head against a wall? It's like arguing abortion with someone whose base world view is that abortion is good.

Hon, I know this may come as a shock to you, but you don't actually know the mind of God. That means you don't know for certain that God actually would regard the sailor's choice as acceptable when he closed the compartment. I leave that open because God forcefully reminds us that His thoughts are higher than ours. God might, to put it bluntly, just not give a $hit about your life or any other person's life on that ship with regard to the decision to sacrifice those on the wrong side of the compartment. God very well might fully expect all of you to willingly risk death and be sorely disappointed in your decision to leave others doomed.

Ask yourself this: do you confidently rule this out? Can you look at God's behavior of self-sacrificial love toward a doomed world and just declare out of hand that God would approve of a decision to sacrifice a few for the safety of many? Or is it equally likely that He would expect the many to accept the risk of death to save the few?

Tony, those are Foxfier's words you quote at the beginning of your comment.

And Mark does quote my words, but then seems to think they belong to "Tony."

You guys are fun.

Bill, I aim to please. Sometimes I please by missing what I aim at. :-)

Foxfier, sorry for the mistake.

God might, to put it bluntly, just not give a $hit about your life or any other person's life on that ship with regard to the decision to sacrifice those on the wrong side of the compartment.

Mike, given that God might also determine the other way and say: "what, you preserved the life of ONE person for an extra 35 seconds, and then you let him and everyone else die! This does not please Me!" I fail to see how your argument persuades. God might not give a dang about any of the lives on the WRONG side of the doors either. So what does that prove? If we are going to risk God's wrath for either choice on the assumption that we don't know "for certain" what the Mind of God judges in this case, we might as well risk it for the choice that is FIRST as close as we can ascertain is pleasing to him, and SECOND as close as we can to one that provides a worthwhile human result, if one and the same choice provides both of those.

If we are going to risk God's wrath for either choice on the assumption that we don't know "for certain" what the Mind of God judges in this case, we might as well risk it for the choice that is FIRST as close as we can ascertain is pleasing to him, and SECOND as close as we can to one that provides a worthwhile human result, if one and the same choice provides both of those.

My point to Foxfier was that we cannot know which one God would take because we cannot ask Him directly. We can only use logic to make good cases for what God might want. She seems to take it for granted that God would just excuse the sailor's decision to lock others behind the compartment when there was some chance to save them.

My point to Foxfier was that we cannot know which one God would take because we cannot ask Him directly. We can only use logic to make good cases for what God might want. She seems to take it for granted that God would just excuse the sailor's decision to lock others behind the compartment when there was some chance to save them.

Perhaps you just wanted to call someone "Hon" and act like an ass. Because I just can't see how she did what you claim in any way.

Perhaps you just wanted to call someone "Hon" and act like an ass. Because I just can't see how she did what you claim in any way.

From what I saw, she was really hard on Bill's side. I consider Bill's side to be the more logically sound application of PDE.

I also make no claim as to having an opinion on whether or not PDE is capable of accurately and precisely (note: I am not being redundant in using both words) be applied to Christian ethics in a world of diverse opportunities for evil to attack us in insidious ways.

As to being "an ass," well, I generally feel no reason to be nice toward those who I feel are condescending toward me. I felt she was in one or two of her responses. In fact, I can be rather unapologetic about my habit of dealing with others on the terms they set for our interaction.

From what I saw, she was really hard on Bill's side. I consider Bill's side to be the more logically sound application of PDE.

I also make no claim as to having an opinion on whether or not PDE is capable of accurately and precisely (note: I am not being redundant in using both words) be applied to Christian ethics in a world of diverse opportunities for evil to attack us in insidious ways.

How this justifies misrepresenting someone as implying they have a God's eye view is beyond me.


How this justifies misrepresenting someone as implying they have a God's eye view is beyond me.

You obviously aren't very good at detecting when someone is using a bit of hyperbole to mock someone's argument.

Considering what we do know about the example that Christ set, which is of self-sacrificial love, it's not "obvious" that God would look kindly on the other sailors closing that trap door unless there was absolutely no reasonable chance that they could save any lives on the other side. It is not obvious, it is simply possible that God would be understanding.

Obviously, if the sailors on the other side are already all but dead, double effect wouldn't apply anyway.

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