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Act / Omission

We can distinguish between a) what someone did and b) what they did not do, but on reflection we can also see that the distinction needs to be further refined. Beginning with a), the notion of doing something may itself be further divided into doing something intentionally and voluntarily, doing it intentionally but non-voluntarily, and doing it unintentionally. In the last case we might then say it was not really something I did, reserving the idea of doing for intentional agency, but more usefully we may say there is a difference between meaning to do something and doing it without meaning to, as for example when looking for one’s fallen glasses one steps on them inadvertently. Turning to b) now excluding from it things one did unintentionally, we have again a broad category that needs to be further divided. There are indefinitely (in fact infinitely) many things anyone did not do or is not doing, and this is so unrestricted that there is really no term for it. Among such things, however, are omissions, understood either as intentional withholdings (deciding not to send a message), or as things which one ought to have done but did not intentionally fail to do (forgetting to send a message). The distinctions between acts and omissions (and between wilful, and forgetful or neglectful omissions) is important in ethics and in law. There is a causal difference between 1) giving a drug so as to bring about someone’s death and 2) not giving a drug knowing that without it they will die, but are the act and the omission morally different? Some people think that in general actions are more morally significant than omissions but this may be due to equating it with the distinction intention and inadvertence.

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    think, that we simply do not have a satisfactory theory of morality, and need to look for it. Scanlon was indeed right in saying that the real answer to utilitarianism depends on progress in the development of alternatives. Meanwhile, however, we have no reason to think that we must accept consequentialism in any form. If the thesis of this paper is correct we should be more alert than we usually are to the possibility that we may unwittingly, and unnecessarily, surrender to consequentialism by uncritically accepting its key idea. Let us remind ourselves that the idea of the goodness of total states of affairs played no part in Aristotle's moral philosophy, and that end p.76 in modern times in plays no part either in Rawls's account of justice or in the theories of more thoroughgoing contractualists such as Scanlon. 18 18 J. Rawls, A Theory of Justice (Cambridge, Mass., 1971): Scanlon, 'Contractualism and Utilitarianism'. If we accustom ourselves to the thought that there is simply a blank where consequentialists see 'the best state of affairs' we may be better able to give other theories the hearing they deserve. 5 Killing and Letting Die end p.77 show chapter abstract and keywords hide chapter abstract and keywords Philippa Foot Is there a morally relevant distinction between killing and allowing to die? Many philosophers say that there is not, and further insist that there is no other closely related difference, as for instance that dividing act from omission, which ever plays a part in determining the moral character of an action. James Rachels has argued this case in his well-known article on active and passive euthanasia, Michael Tooley has argued it in his writings on abortion, and Jonathan Bennett argued it in the Tanner Lectures given in Oxford in 1980. 1 James Rachels, 'Active and Passive Euthanasia', New England Journal of Medicine, 292 (9 Jan. 1975); Michael Tooley, 'Abortion and Infanticide', Philosophy and Public Affairs, 2/1 (Fall 1972). Jonathan Bennett, 'Morality and Conscience', in S. McMurrin (ed.), The Tanner Lectures on Human Values, vol. ii (Cambridge: Cambridge University Press, 1981). I believe that these people are mistaken, and this is what I shall try to show in this essay. I shall first consider the question in abstraction from any particular practical moral problem, and then I shall examine the implications my thesis may have concerning the issue of abortion. The question with which we are concerned has been dramatically posed by asking whether we are as much to blame for allowing people in Third World countries to starve to death as we would be for killing them by sending poisoned food? In each case it is true that if we acted differently-by sending good food or by not sending poisoned food-those who are going to die because we do not send the good food or do send the end p.78 poisoned food would not die after all. Our agency plays a part in what happens whichever way they die. Philosophers such as Rachels, Tooley, and Bennett consider this to be all that matters in determining our guilt or innocence. Or rather they say that although related things are morally relevant, such as our reasons for acting as we do and the cost of acting otherwise, these are only contingently related to the distinction between doing and allowing. If we hold them steady and vary only the way in which our agency enters into the matter, no moral differences will be found. It is of no significance, they say, whether we kill others or let them die, or whether they die by our act or our omission. Although these latter differences may at first seem to affect the morality of action, we shall always find on further enquiry that some other difference-such as a difference of motive or cost-has crept in. Now this, on the face of it, is extremely implausible. We are not inclined to think that it would be no worse to murder to get money for some comfort such as a nice winter coat than it is to keep the money back before sending a donation to Oxfam or Care. We do not think that we might just as well be called murderers for one as for the other. And there are a host of other examples which seem to make the same point. We may have to allow one person to die if saving him would mean that we could not save five others, as for instance when a drug is in short supply and he needs five times as much as each of them, but that does not mean that we could carve up one patient to get 'spare parts'for five. These moral intuitions stand clearly before us, but I do not think it would be right to conclude from the fact that these examples all seem to hang on the contrast between killing and allowing to die that this is precisely the distinction that is important from the moral point of view. For example, having someone killed is not strictly killing him, but seems just the same morally speaking; and on the other hand, turning off a respirator might be called killing, although it seems morally indistinguishable from allowing to die. Nor does it seem that the difference between "act" and "omission"is quite what we want, in that a respirator that had to be turned on each morning would not change the moral problems that arise with the ones we have now. Perhaps there is no locution in the language which exactly serves our purposes and we should therefore invent end p.79 our own vocabulary. Let us mark the distinction we are after by saying that one person may or may not be "the agent"of harm that befalls someone else. When is one person "the agent"in this special sense of someone else's death, or of some harm other than death that befalls him? This idea can easily be described in a general way. If there are difficulties when it comes to detail, some of these ideas may be best left unsolved, for there may be an area of indefiniteness reflecting the uncertainty that belongs to our moral judgements in some complex and perhaps infrequently encountered situations. The idea of agency, in the sense that we want, seems to be composed of two subsidiary ideas. First, we think of particular effects as the result of particular sequences, as when a certain fatal sequence leads to someone's death. This idea is implied in coroners'verdicts telling us what someone died of, and this concept is not made suspect by the fact that it is sometimes impossible to pick out a single fatal sequence—as in the lawyers'example of the man journeying into the desert who had two enemies, one of whom bored a hole in his water barrel while the other filled it with brine. Suppose such complications absent. Then we can pick out the fatal sequence and go on to ask who initiated it. If the subject died by poisoning and it was I who put the poison into his drink, then I am the agent of his death; likewise if I shot him and he died of a bullet wound. Of course there are problems about fatal sequences which would have been harmless but for special circumstances, and those which although threatening would have run out harmlessly but for something that somebody did. But we can easily understand the idea that a death comes about through our agency if we send someone poisoned food or cut him up for spare parts, but not (ordinarily) if we fail to save him when he is threatened by accident or disease. Our examples are not problem cases from this point of view. Nor is it difficult to find more examples to drive our original point home, and show that it is sometimes permissible to allow a certain harm to befall someone, although it would have been wrong to bring this harm on him by one's own agency, by originating or sustaining the sequence which brings the harm. Let us consider, for instance, a pair of cases which I shall call Rescue I and Rescue II. In the first Rescue story we are hurrying end p.80 in our jeep to save some people-let there be five of them who are imminently threatened by the ocean tide. We have not a moment to spare, so when we hear of a single person who also needs rescuing from some other disaster we say regretfully that we cannot rescue him, but must leave him to die. To most of us this seems clear, and I shall take it as clear, ignoring John Taurek's interesting if surprising argument against the obligation to save the greater number when we can. 2 John Taurek, 'Should the Numbers Count?', Philosophy and Public Affairs, 4 (Summer 1977). This is Rescue I and with it I contrast Rescue II. In this second story we are again hurrying to the place where the tide is coming in in order to rescue the party of people, but this time it is relevant that the road is narrow and rocky. In this version the lone individual is trapped (do not ask me how) on the path. If we are to rescue the five we would have to drive over him. But can we do so? If we stop he will be all right eventually: he is in no danger unless from us; but of course all five of the others will be drowned. As in the first story our choice is between a course of action which will leave one man dead and five alive at the end of the day and a course of action which will have the opposite result. And yet we surely feel that in one case we can rescue the five men and in the other we cannot. We can allow someone to die of whatever threatens him if the cost of saving him is failing to save five; we cannot, however, drive over him in order to get to them. We cannot originate a fatal sequence, although we can allow one to run its course. Similarly, in the pair of examples mentioned earlier, we find a contrast between on the one hand refusing to give to one man the whole supply of a scarce drug, because we can use portions of it to save five, and on the other, cutting him up for spare parts. And we notice that we may not originate a fatal sequence even if the resulting death is in no sense our object. We could not knowingly subject one person to deadly fumes in the process of manufacturing some substance that would save many, even if the poisoning were a mere side effect of the process that saved lives. Considering these examples, it is hard to resist the conclusion that it makes all the difference whether those who are going to die if we act in a certain way will die as a result of a sequence that we originate or of end p.81 one that we allow to continue, it being of course something that did not start by our agency. So let us ask how this could be? If the distinction which is roughly that between killing and allowing to die is morally relevant, because it sometimes makes the difference between what is right and what is wrong, how does this work? After all, it cannot be a magical difference, and it does not satisfy anyone to hear that what we have is just an ultimate moral fact. Moreover, those who deny the relevance can point to some cases in which it seems to make no difference to the goodness or badness of an action having a certain result, as, for example, that some innocent person dies, whether that is due to a sequence we originate or one we merely allow. And if the way the result comes about sometimes makes no difference, how can it ever do so? If it sometimes makes an action bad that harm came to someone else as a result of a sequence we originated, must this not always contribute some element of badness? How can a consideration be a reason for saying that an action is bad in one place without being at least a reason for saying the same elsewhere? Let us address these questions. As to the route by which considerations of agency enter the process of moral judgement, it seems to be through its connection with different types of rights. For there are rights to non-interference, which form one class of rights; and there are rights to goods or services, which are different. And corresponding to these two types of rights are, on the one hand, the duty not to interfere, called a "negative duty", and on the other the duty to provide the goods or services, called a "positive duty". These rights may in certain circumstances be overridden, and this can in principle happen to rights of either kind. So, for instance, in the matter of property rights, others have in ordinary circumstances a duty not to interfere with our property, though in exceptional circumstances the right is overridden, as in Elizabeth Anscombe's example of destroying someone's house to stop the spread of a fire. 3 3 G. E. M. Anscombe, 'Modern Moral Philosophy', Philosophy, 33 (1958). And a right to goods or services depending, for example, on a promise will quite often be overridden in the same kind of case. There is, however, no guarantee that the special circumstances end p.82 that allow one kind of right to be overridden will always allow the overriding of the other. Typically, it takes more to justify an interference than to justify the withholding of goods or services; and it is, of course, possible to think that nothing whatsoever will justify, for example, the infliction of torture or the deliberate killing of the innocent. It is not hard to see how all this connects with the morality of killing and allowing to die-and in general with harm which an agent allows to happen and harm coming about through his agency, in my special sense having to do with originating or sustaining harmful sequences. For the violation of a right to non-interference consists in interference, which implies breaking into an existing sequence and initiating a new one. It is not usually possible, for instance, to violate that right to noninterference, which is at least part of what is meant by "the right to life", by failing to save someone from death. So if, in any circumstances, the right to non-interference is the only right that exists, or if it is the only right special circumstances have not overridden, then it may not be permissible to initiate a fatal sequence, but it may be permissible to withhold aid. The question now is whether we ever find cases in which the right to non-interference exists and is not overridden, but where the right to goods or services either does not exist or is here overridden. The answer is, of course, that this is quite a common case. It often happens that whereas someone's rights stand in the way of our interference, we owe him no service in relation to that which he would lose if we interfered. We may not deprive him of his property, though we do not have to help him secure his hold on it, in spite of the fact that the balance of good and evil in the outcome (counting his loss or gain and the cost to us) will be the same regardless of how they come about. Similarly, where the issue is one of life and death, it is often impermissible to kill someone-although special circumstances having to do with the good of others make it permissible, or even required, that we do not spend the time or resources needed to save his life, as, for instance, in the story of Rescue 1, or in that of the scarce drug. It seems clear, therefore, that there are circumstances in which it makes all the difference, morally speaking, whether a given balance of end p.83 good and evil came about through our agency (in my sense), or whether it was rather something we had the ability to prevent but, for good reasons, did not prevent. Of course we often have a strict duty to prevent harm to others, or to ameliorate their condition. And even where they do not, strictly speaking, have a right to our goods or services, we should often be failing (and sometimes grossly failing) in charity if we did not help them. But, to reiterate, it may be right to allow one person to die in order to save five, although it would not be right to kill him to bring the same good to them. How is it, then, that anyone has ever denied this conclusion, so sympathetic to our everyday moral intuitions and apparently so well grounded in a very generally recognized distinction between different types of rights? We must now turn to an argument first given by James Rachels, and more or less followed by others who think as he does. Rachels told a gruesome story of a child drowned in a bathtub in two different ways: in one case someone pushed the child's head under water, and in the other he found the child drowning and did not pull him out. Rachels says that we should judge one way of acting as bad as the other, so we have an example in which killing is as bad as allowing to die. But how, he asks, can the distinction ever be 4 relevant if it is not relevant here? 4 Rachels, 'Active and Passive Euthanasia'. Based on what has been said earlier, the answer to Rachels should be obvious. The reason why it is, in ordinary circumstances, 'no worse' to leave a child drowning in a bathtub than to push it under is that both charity and the special duty of care that we owe to children give us a positive obligation to save them, and we have no particular reason to say that it is 'less bad' to fail in this than it is to be in dereliction of the negative duty by being the agent of harm. The level of badness is, we may suppose, the same, but because a different kind of bad action has been done, there is no reason to suppose that the two ways of acting will always give this same result. In other circumstances one might be worse than the other, or only one might be bad. And this last result is exactly what we find in circumstances that allow a positive but not a negative duty to be overridden. end p.84 Thus, it could be right to leave someone to die by the roadside in the story of Rescue I, though wrong to run over him in the story of Rescue II; and it could be right to act correspondingly in the cases of the scarce drug and the 'spare parts'. Let me now consider an objection to the thesis I have been defending. It may be said that I shall have difficulty explaining a certain range of examples in which it seems permissible, and even obligatory, to make an intervention which jeopardizes people not already in danger in order to save others who are. The following case has been discussed. Suppose a runaway tram is heading towards a track on which five people are standing, and that there is someone who could switch the points, thereby diverting the tram onto a track on which there is only one person. It seems that he should do this, just as a pilot whose plane is going to crash has a duty to steer, if he can, towards a less crowded street than the one he sees below. But the railway man then puts the one man newly in danger, instead of allowing the five to be killed. Why does not the one man's right to non-interference stand in his way, as one person's right to noninterference impeded the manufacture of poisonous fumes when this was necessary to save five? The answer seems to be that this is a special case, in that we have here the diverting of a fatal sequence and not the starting of a new one. So we could not start a flood to stop a fire, even when the fire would kill more than the flood, but we could divert a flood to an area in which fewer people would be drowned.

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    Is Every Action Morally Significant? - Volume 86 Issue 3

  • Action and Conduct: Thomas Aquinas and the Theory of Action

    "Both Thomistic scholars and analytic philosophers interested in theories of human action and accountability will find this book a welcome addition to their libraries. Truly a substantive addition to both Thomistic scholarship and the ongoing analytic investigation into human action and responsible agency." - American Catholic Philosophical Quarterly"A tremendously successful exposition of Aquinas, which brings him into conversation with contemporary and analytic philosophy in a mutually illuminating way. Action and Conduct is so thorough and so lucid that no students of Aquinas or of contemporary action theory can afford to neglect it." - Modern Theology"A first rate book...Brock's lucid and illuminating analysis offers much of value to both intellectual historians and theologians, as well as philosophers." - Theological Studies"Brock's treatment of Aquinas's account of action exhibits a rare combination of rigor and learning. It is, no doubt, the best we have." - The Thomist

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    Contrary to the view of Frances Kamm and Jeff McMahan that we can let something happen by acting – e.g., let somebody die by turning off a life-sustaining apparatus – it is argued in this entry that ...

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    Ethical and Religious Directives for Catholic Health Care Services Sixth Edition UNITED STATES CONFERENCE OF CATHOLIC BISHOPS Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition This sixth edition of the Ethical and Religious Directives for Catholic Health Care Services was developed by the Committee on Doctrine of the United States Conference of Catholic Bishops (USCCB) and approved by the USCCB at its June 2018 Plenary Assembly. This edition of the Directives replaces all previous editions, is recommended for implementation by the diocesan bishop, and is authorized for publication by the undersigned. Msgr. J. Brian Bransfield, STD General Secretary, USCCB Excerpts from Documents of Vatican II, ed. Walter M. Abbott, SJ, copyright 1966 by America Press are used with permission. All rights reserved. Scripture texts used in this work are taken from the New American Bible, copyright © 1991, 1986, and 1970 by the Confraternity of Christian Doctrine, Washington, DC, 20017 and are used by permission of the copyright owner. All rights reserved. Digital Edition, June 2018 Copyright © 2009, 2018, United States Conference of Catholic Bishops, Washington, DC. All rights reserved. No part of this work may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright holder. 2 Contents 4 6 8 10 13 16 20 23 Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition 27 Preamble General Introduction PART ONE The Social Responsibility of Catholic Health Care Services PART TWO The Pastoral and Spiritual Responsibility of Catholic Health Care PART THREE The Professional-Patient Relationship PART FOUR Issues in Care for the Beginning of Life PART FIVE Issues in Care for the Seriously Ill and Dying PART SIX Collaborative Arrangements with Other Health Care Organizations and Providers Conclusion 3 Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition Preamble Health care in the United States is marked by extraordinary change. Not only is there continuing change in clinical practice due to technological advances, but the health care system in the United States is being challenged by both institutional and social factors as well. At the same time, there are a number of developments within the Catholic Church affecting the ecclesial mission of health care. Among these are significant changes in religious orders and congregations, the increased involvement of lay men and women, a heightened awareness of the Church's social role in the world, and developments in moral theology since the Second Vatican Council. A contemporary understanding of the Catholic health care ministry must take into account the new challenges presented by transitions both in the Church and in American society. Throughout the centuries, with the aid of other sciences, a body of moral principles has emerged that expresses the Church's teaching on medical and moral matters and has proven to be pertinent and applicable to the ever-changing circumstances of health care and its delivery. In response to today's challenges, these same moral principles of Catholic teaching provide the rationale and direction for this revision of the Ethical and Religious Directives for Catholic Health Care Services. These Directives presuppose our statement Health and Health Care published in 1981.¹ There we presented the theological principles that guide the Church's vision of health care, called for all Catholics to share in the healing mission of the Church, expressed our full commitment to the health care ministry, and offered encouragement to all those who are involved in it. Now, with American health care facing even more dramatic changes, we reaffirm the Church's commitment to health care ministry and the distinctive Catholic identity of the Church's institutional health care services. The purpose of these Ethical and Religious Directives then is twofold: first, to reaffirm the ethical standards of behavior in health care that flow from the Church's teaching about the dignity of the human person; second, to provide authoritative guidance on certain moral issues that face Catholic health care today. The Ethical and Religious Directives are concerned primarily with institutionally based Catholic health care services. They address the sponsors, trustees, administrators, chaplains, physicians, health care personnel, and patients or residents of these institutions and services. Since they express the Church's moral teaching, these Directives also will be helpful to Catholic professionals engaged in health care services in other settings. The moral teachings that we profess here flow principally from the natural law, understood in the light of the revelation Christ has entrusted to his Church. From this source the Church has derived its understanding of the nature of the human person, of human acts, and of the goals that shape human activity. The Directives have been refined through an extensive process of consultation with bishops, theologians, sponsors, administrators, physicians, and other health care providers. While providing standards and guidance, the Directives do not cover in detail all of the complex issues that confront Catholic health care today. Moreover, the Directives will be reviewed periodically by the United States Conference of Catholic Bishops (formerly the National Conference of Catholic Bishops), in the light of authoritative church teaching, in order to address new insights from theological and 4 Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition medical research or new requirements of public policy. The Directives begin with a general introduction that presents a theological basis for the Catholic health care ministry. Each of the six parts that follow is divided into two sections. The first section is in expository form; it serves as an introduction and provides the context in which concrete issues can be discussed from the perspective of the Catholic faith. The second section is in prescriptive form; the directives promote and protect the truths of the Catholic faith as those truths are brought to bear on concrete issues in health care. 5

  • The Scope of Intention: Action, Conduct, and Responsibility

    Part of the Royal Institute of Philosophy's London Lecture series 2015: The Philosophy of Action. The abstract of this lecture is presented below: Intention takes various forms. Must its objects be acts or activities? Even apart from the types of objects intention can have, there is the question of how much can be encompassed in the content of a single intention. A further question here is whether intentions can have the content: to A for R, where ‘A’ ranges over act-types and ‘R’ over reasons for action, for instance to keep my promise. The question is particularly important on the widely accepted assumption that, for concrete actions (act-tokens) that are rational and have moral worth, both their rationality and their moral worth depend on the reason(s) for which they are performed. If intentions can have content of the form of ‘to A for R’, should we conclude that (contrary to the position of Kant and many others) we have voluntary control—even direct voluntary control—of the reason(s) for which we act? If intentions cannot have such content, how can we intend to act rationally or intend to do, not just what we ought to do, but to do it with “moral worth”? This question is also raised by the idea that we can be commanded (enjoined, urged, and the like) to treat others as ends in themselves—which presumably has moral worth. If the commandable is intendable, we need a theory of the scope of intention to understand commands and other directives. This paper explores kinds and objects of intention, proposes an account of its scope, and brings out some of its implications for moral responsibility.

  • Doing and Allowing Harm

    Doing harm seems much harder to justify than merely allowing harm. If a boulder is rushing towards Bob, you may refuse to save Bob's life by driving your car into the path of the boulder if doing so would cost you your own life. You may not push the boulder towards Bob to save your own life. This principle--the Doctrine of Doing and Allowing--requires defence. Does the distinction between doing and allowing fall apart under scrutiny? When lives are at stake, how can it matter whether harm is done or allowed? Drawing on detailed analysis of the distinction between doing and allowing, Fiona Woollard argues that the Doctrine of Doing and Allowing is best understood as a principle that protects us from harmful imposition. Such protection against imposition is necessary for morality to recognize anything as genuinely belonging to a person, even that person's own body. As morality must recognize each person's body as belonging to her, the Doctrine of Doing and Allowing should beaccepted. Woollard defends a moderate account of our obligations to aid, tackling arguments by Peter Singer and Peter Unger that we must give most of our money away and arguments from Robert Nozick that obligations to aid are incompatible with self-ownership.

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    Christian and Moral Action

    In Christian and Moral Action, Fr. Flannery teaches us the principles by which we judge an act. He explains that the morality of an action lies in its intelligibility and rationality–whether it is ordered to a good end. We are given the tools to determine whether any action is intelligible and rational by learning to consider its intention, circumstances, and object. Recorded in 2007.

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    Good and Bad in Human Action

    University of Chicago Humanities Day October 19, 2013 "Good and Bad in Human Action" Candace Vogler, David B. and Clara E. Stern Professor and Chair of the Department of Philosophy Aristotle held that all action aims at the good and Aquinas held that a primary orientation to the good cannot be obliterated from human hearts or minds. For anyone who pays any attention to current events or to accounts of hideous things that people have done in the past, this thought looks very odd. Why would anyone think that people in general seek to pursue good and avoid bad? Where can we even look to find an orientation to good in human beings generally? In this talk, Candace Vogler draws from a number of sources in the course of beginning to answer these questions. If you experience any technical difficulties with this video or would like to make an accessibility-related request, please send a message to [email protected].