Against the intention-based objection to euthanasia
In this post, Harrison Lee (University of Mississippi) discusses his article recently published in the Journal of Applied Philosophy on the intention-based objection to euthanasia.
Many opponents of euthanasia argue that it is impermissible simply because it involves intentionally killing a patient. By contrast, they often accept practices like palliative sedation (PS), even when these foreseeably hasten death. The usual explanation appeals to the doctrine of double effect: it is sometimes permissible to cause harm or evil as a foreseen side effect, but never permissible to cause it as an intended means.
I want to challenge this way of thinking. The distinction between intending death and merely foreseeing it does not do the moral work it is often taken to do in arguments against euthanasia. In particular, there are cases in which it is clearly permissible to act because one will thereby cause death—and it is hard to maintain that acting in order to cause death is any worse.
A simple thought about everyday reasoning helps set the stage. Suppose you throw a party because you know your friends will feel obliged to clean up afterwards. You throw the party in order to have fun—but only because your friends will help you clean up afterwards. Still, it would be odd to say that you throw the party in order to cause your friends to help you clean up the resulting mess. That would be irrational, since the mess would not even exist in the first place if you did not throw the party. The fact that your friends will clean up is a reason for your action, but not its aim.
Something similar could happen in medical cases:
Fanatical Director Scenario
Mr. Gray is in severe distress near the end of his life. Dr. Clemens can administer palliative sedation (PS) to relieve his suffering while he is still alive.
The hospital director, Dr. Smith, fanatically opposes PS. If PS is administered and the patient is still alive at 5:30 PM, Smith will torture him as punishment. If no PS is administered, Smith does nothing.
Dr. Clemens knows:
– If she administers PS at 5:00 PM, it will cause Mr. Gray to die by 5:20 PM.
– If she does not administer PS, Mr. Gray will not be tortured.
She administers PS in order to relieve Mr. Gray’s suffering while he is still alive. She is also aware that doing so will cause him to die before 5:30 PM and thus will not subject him to Smith’s abuses.
How should we describe Dr. Clemens’s reasoning?
It would be a mistake to say that she administers PS in order to make Mr. Gray die before 5:30 PM. It would be irrational for her to administer PS to Mr. Gray in order to protect him from abuses (at the hands of Dr. Smith) that he would not be subjected to in the first place if she did not administer it. Indeed, this would be just as irrational as throwing a party in order to cause your friends to clean a mess that would not exist if you did not throw it.
Instead, the right description is this: she administers PS in order to relieve Mr. Gray’s suffering while he is still alive, and she does so because she knows that doing so will not expose him to further harm—since it will bring about his death before Dr. Smith can intervene.
In other words, the fact that Mr. Gray will die is part of her reasoning, but not her goal. It reassures her that administering PS will not backfire and make things worse. The prospect of death functions as a reason in favor of the action, but she does not perform the action in order to cause death.
The crucial point is that Dr. Clemens’s action appears permissible. It would clearly be permissible to administer PS if the fanatical director were not present. And it is hard to see how his mere presence could make it impermissible to do what is best for the patient when, given the timing, he will not in fact be harmed by him.
I think it follows that it can be permissible to intentionally cause death as a means of relieving suffering. If death were always an evil that must not guide our actions, then it would be morally problematic for Dr. Clemens to be guided by the prospect of causing Mr. Gray to die. But this is not the case.
Why is it permissible for Dr. Clemens to be guided by the prospect of killing her patient? I think he answer is very simple. It is that Mr. Gray’s death will benefit him by preventing him from being tortured by Dr. Smith, and thus, from suffering a greater harm.
Opponents of euthanasia might respond by arguing that it is wrong for physicians to intentionally kill even where death benefits the one who dies. For example, they might argue that intentionally causing death always violates the aims of medicine or the dignity of the patient.
But these objections also imply—implausibly—that Dr. Clemens acts impermissibly in Fanatical Director. Dr. Clemens is guided in part by the fact that administering PS will cause Mr. Gray to die. If being guided by the prospect of causing death were always morally corrupting or incompatible with medical practice, then her action should be impermissible too. But it is not.
The deeper lesson is that death is not always an unconditional evil in medical decision-making. Sometimes, given the alternatives, death can benefit the patient by preventing a greater harm. Once we recognize this, the intention-based objection to euthanasia loses much of its force. The mere fact that euthanasia involves intending death is not enough, by itself, to show that it is impermissible.
Harrison Lee is currently a Visiting Assistant Professor of Philosophy at the University of Mississippi and will join UCLA as a Postdoctoral Clinical Ethics Fellow in 2026. His research focuses on bioethics and normative ethics.
