Medical Ethics
Michael Green
Manuel Vargas
phone, office information

24 April. Passive and active euthanasia
27 April. Intended vs. extraordinary means
4 May. Can it be worse to have more choices?
6 May. Would it be unfair if the poor used PAS more?

Medical Ethics: 29 April. Are intentions relevant to the moral assessment of actions?

What Rachels needs

I believe that Rachels's argument rests on an assumption that is false: that actions and intentions are clearly distinct. I think this is false for two reasons.

1. All actions are preceded by intentions.

What distinguishes an action from a bodily movement, in my opinion, is that actions are intentional. Suppose I act in this way: I push you. This happens because my body moves as a result of my having intended to push you.

Thus, you will think that I acted wrongly if I pushed you into a large angry man or you will think I acted rightly if I push you out of the way of a bus.

By contrast, if I bump up against you because, say, the wind blew me in your direction, that would not be an action of mine, as I see it. Rather, it would be, at most, my body moving.

I won't receive either blame or praise if it's just the wind.

2. Intentions enable us to pick the best description of what a person is doing.

There are an infinite number of descriptions of what I'm doing right now. Here's a small sample: wearing out a keyboard, wasting a nice day, occupying space, digesting lunch, respirating, and typing the class notes.

Are all of these my actions? These are all things that are happening. But the only description that picks out what I'm doing is the last one. And that's the best one because it best describes what I intend to do by moving my fingers like this.

Answering Kate's example

I thought Kate had an interesting point: to truthfully say "he's running down the street," we don't need to know much about his intentions.

I think we need to know something about them: we need to know that he is intentionally doing something in order to describe him as running down the street. For example, if he were sleepwalking, I would say that about him, not that he's running down the street. If the wind were blowing him and he was moving his arms as if he were running, it wouldn't be right to say that he was running down the street. And so on.

But there's still a point here, isn't there? You need to know almost nothing about his intentions to accurately say "he's running down the street."

That's true. But there are more accurate descriptions of what he is doing. Is he jogging? Is he running away from a cop? Is he running to catch the bus? Is he trying to wear out his shoes by four o'clock?

To get the most accurate description of what he's doing, we'll have to appeal to his intentions. In other words, the most accurate description of his action will be determined by his intentions.

The moral

Actions always have intentions, you can't separate the one from the other. Thus, it's inaccurate to say that Jack and Jill did exactly the same thing, albeit with different intentions.

The battle and the war

I think Sullivan wins this battle, but that he's still losing the war.

What if Rachels had admitted that the moral value of intentions is relevant to the moral assessment of actions but then said that it's not always bad to intend to kill?

For example, a doctor who engages in active euthanasia for the sake of ending his patient's extreme misery intentionally kills his patient. But is that obviously an evil intention? Rachels's examples make this seem like the humane and merciful thing to do (in those specific instances, of course, not in general).

Nothing Sullivan has said so far has done anything to undermine that view. How does Sullivan expect to overcome those examples? We can talk about intentions all day and he'll never get any closer to showing that it's wrong of a doctor to end his patient's abject misery.

That's my opinion, at any rate.

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