More from Karen Stohr on Ectopic Pregnancies and Double Effect

[Karen (Georgetown, Philosophy) sent this e-mail message to Richard, Rob, and me.  The conversation continues ...]

Richard, I appreciate your thoughful reply [here], but as you might guess, I am not satisfied. I think we actually largely agree about this:  "It seems a much too facile way of just "redescribing" the actions of the doctor." 

It *is* facile (or at least, arbitrary) unless it is accompanied by an action theory that justifies sorting the descriptions that way. The same, however, applies to the way you want to to sort out action descriptions. You and others suggest sorting them this way:

"It doesn't focus adequately on the physical act that is being undertaken."

But I don't see how this helps. Indeed, I think it obscures the very issues that need to be settled within action theory. For what exactly is the physical act in question? What grounds are you using for saying that the craniotonomy/salpingostomy constitutes the physical act of killing the baby, whereas a hysterectomy/salpingectomy does not? Both, of course, are physical acts of some sort, and obviously they have the same result. In order to argue that the one constitutes killing whereas the other does not, you need to have a theory of action individuation that allows us to identify all and only cases of killing.

But let us suppose that we have such a theory and agree that craniotomies and salpingostomies constitute killings, whereas hysterectomies and salpingectomies do not. In order to argue that the former are grave moral wrongs, you would *also* need to argue that they are intentional killings, that death is the aim. And this is what I do not think that the physical description alone can get you. (After all, the cardiac surgeon and the knife-wielding murderer may be doing exactly the same physical act, but the one is attempting heart surgery and the other is attempting murder.)

In sum, there are two steps in the argument that still need justification in order for the salpingectomy/salpingostomy distinction to succeed. First, it needs to be argued that the salpingostomy is properly described as killing at all, and then it also needs to be argued that it is intentional killing. Pointing to the physical act gets you only to the first of those, if even that. But you need something more to get to the second part of the claim, and that something more will have to involve a theory of intention.

Those defending the Grisez-Boyle-Finnis line have an equal burden of argumentation. I do think that position has better philosophical grounding than the one you defend, but this could certainly be disputed. And this again is why the application of double effect troubles me so much, as it can amount to holding real people hostage to shaky philosophical distinctions.

Best,
Karen