The Because/in Order to Distinction and the Ethics of Euthanasia: Demonstrating that Death Is Not an Unconditional Evil for Double Effect Analysis

ABSTRACT Many ethicists who have opposed euthanasia have nonetheless approved of the administration of palliative sedation (PS) under conditions where they have believed it is likely to hasten death. This reasoning typically reflects the doctrine of double effect (DDE), which prohibits causing evil intentionally but permits causing it merely foreseeably under some circumstances. In other ethical contexts, Frances Kamm has emphasized another distinction, namely the distinction between performing an action because one will thereby cause some consequence and performing an action in order to (i.e. from an intention to) cause a consequence. Here I argue that it could be permissible to administer PS to a patient because one would thereby cause him to die rather than causing him to endure suffering that would be worse for him than death. However, I argue that the because/in order to distinction is ethically insignificant in this context. It is no worse, I argue, to act in order to cause a patient to die than it would be to act because one would thereby cause a patient to die. Thus, I conclude that death is not an unconditional evil for the purposes of DDE analysis, and that euthanasia can be permissible.