Abstract
In traditional ethical analyses of end-of-life decision-making the concept of intention plays a crucial role. Through a review of qualitative research and clinically informed analyses of different end-of-life practices such as non-treatment decisions, aggressive symptom relief and palliative sedation, this chapter investigates the role intention plays in contemporary end-of-life practices. Qualitative studies put into doubt two common presuppositions about the intentions of health professionals: that these are directly accessible to the agent, and that they are unambiguous. Two rival interpretations of the findings, which take diametrically opposed views of the helpfulness of the concept of intention and the Principle of Double Effect, are outlined. Finally, by way of a theoretical account of intention, we present our own interpretation and the claim that it is indeed possible to practice excellent end-of-life care without having to intend (the hastening of) a patient’s death.
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Notes
- 1.
Woods and Graven offer a four-point definition of what they call the ‘Doctrine of Double Effect’: 1. The act itself must be of a permissible kind (morally good) or at least indifferent (morally neutral). 2. The agent may not positively intend the bad effect but may foresee it (and allow it to happen) but if there were a means to achieve the good effect without the bad effect then that would be the preferred option. 3. The good effect must be produced directly by the action, and not by the bad effect. The agent must not use a bad means to a good end, which is never allowed. 4. The good effect must be sufficiently important to compensate for the allowing of the bad effect. (See Chap. 12, this volume).
- 2.
In October 2017, Ovid MEDLINE, PsycINFO and Embase were searched with relevant keywords, yielding 196 references. 131 articles were deemed irrelevant from the title, or were not in English, or were not full journal articles. The remaining 65 articles were assessed by abstract when available, resulting in 17 articles judged potentially relevant. These were evaluated in full text, and 11 articles were found to fit the search criteria. Further detail of the literature search is available on request to the first author.
- 3.
The limits to the usefulness of the ‘counterfactual test’ has been noted in Shaw (2006; 201–204).
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Magelssen, M., Shaw, J. (2020). Intentions of Physicians and End of Life Care Team. In: Emmerich, N., Mallia, P., Gordijn, B., Pistoia, F. (eds) Contemporary European Perspectives on the Ethics of End of Life Care. Philosophy and Medicine, vol 136. Springer, Cham. https://doi.org/10.1007/978-3-030-40033-0_21
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