Philippa Foot, “The Problem of Abortion and the Doctrine of the Double Effect”
Posted: Mon, Sep 29, 2025
Axiological theories of right: The deontic status of an action is fully and directly grounded in its value.
- Analogy: H & O atoms make up H2O molecules which in turn make up the water in my bottle.
- Direct grounds: To say that the water in my bottle is made of H2O is not deny that it is further made of hydrogen and oxygen atoms.
- Full grounds: No other molecules make up the water in my bottle.
- Consequentialism: The deontic status of an action is grounded fully and directly in the value of its consequences.
Deontological theories of right: The deontic status of an action is not fully and directly grounded in its value.
- Possibilities:
- Denying full grounds: Either considerations of value do not matter at all or other considerations also matter morally.
- Denying direct grounds: Either considerations of value do not matter at all or they matter only indirectly.
- The defining deontological objection: At least sometimes, two axiologically identical actions may differ in deontic status.
The “sacrifice one to save five” pairs of cases
| Case | Intuition | |
|---|---|---|
| Pair I | Drug: Giving a lifesaving drug to one vs five [who each need 1/5] | Right |
| Serum: Killing one to make a serum to save five | Wrong | |
| Pair II | Runaway trolley (driver ver.): Diverting the trolley from five, hitting one | Right |
| Blackmail: Executing one innocent person to save five | Wrong |
An adequate moral theory should either explain or explain away this pattern.
- The deontological objection: Axiological theories in general and consequentialist theories in particular cannot.
- In-class activity: What can a consequentialist say for themself?
- Motivation for a deontological constraint: What matters morally is not just how good the consequences are, but the ways in which these consequences are brought about.
Two competing explanations
- The Doctrine of the Double Effect: It is at least sometimes [when?] morally permissible to bring about bad consequences if they are merely foreseen rather than intended.
- “Sometimes”: Deaths due to snake oil may be merely foreseen but are nevertheless wrongful; the bad consequences must be justified.
- Intended consequences are aimed at either as the agent’s end or as a means to the agent’s end (either way: they are part of the plan); merely foreseen consequences are not so intended.
- Example: Going to class on a rainy day.
- Intended/part of the plan:
- End: Arriving at the classroom.
- Means to the end: Getting on the 1 train, climbing stairs, etc.
- Merely foreseen/not part of the plan:
- Getting my clothes wet, scanning ID to enter campus (!), etc.
- Intended/part of the plan:
- Pair I: The death of the one patient is intended in the serum case but not in the drug case.
- Pari II: The death of the innocent person is intended in the blackmail case but not in the trolley (driver) case.
- A distinction between doing and allowing harm: “To refrain from inflicting injury ourselves is a stricter duty than to prevent other people from inflicting injury, which is not to say that the other is not a very strict duty indeed” (p. 13).
- Allowing harm is failing to prevent harm (“letting die”); doing harm is causing harm (“killing”).
- Not the intending/merely foreseeing distinction; also not the act/omission distinction.
| Intending harm | Merely foreseeing harm | |
|---|---|---|
| Doing harm | Serum & blackmail cases | Trolley (driver) case |
| Allowing harm | Murder by letting drown (i.e., “bathtub” case) | Drug case |
Note that the trolley (driver) case is special: The choice is between killing one vs. five.
| Act | Omission | |
|---|---|---|
| Doing harm | Making vaccines inaccessible | Not providing medical care for trans patients |
| Allowing harm | Withdrawing treatment (e.g., “pulling the plug”) | Withholding treatment (e.g., non-resuscitation) |
Foot’s counterexample to double effect
The lethal fumes case (p. 13): Manufacture lifesaving gas to save five, releasing lethal gas killing one.
- Foot takes it that this is a case where the doctrine of the double effect applies: It is after all structurally identical to the trolley (driver) case.
- The doctrine of the double effect must explain why releasing lethal fumes is wrong but diverting the trolley as the driver is not.
- Foot suggests that it can’t: The death of the one is not part of the plan/not a means to saving the five it is a merely foreseen consequence.
- She argues that we need the distinction between doing and allowing harm for this: Even though you merely foresee that the one patient will die, you bring about their death.