Living morally is not just a matter of fulfilling one’s obligations, important though that is. It requires a stable pattern of moral conduct, which should not only meet the standards expressed by the commonsense principles described in Chapter 4 but also meet the two higher-level standards proposed in Chapter 5. Living morally does not require that everything we do be morally motivated, but it does require appropriate conduct. This is the three-dimensional kind of behavior identifiable by asking thick moral questions. These concern not just what we should do but also the other two dimensions of conduct: first, what our motivation would be and second, the manner in which we would act. How, in practice, we are to frame and sustain intentions to achieve good conduct is a difficult matter, and it calls for descriptions of the different kinds of guiding intentions that put moral conduct on life’s itinerary.

This chapter puts forward a novel healthcare application of the Trolley Problem by applying it to our most recent global health crisis, the COVID-19 pandemic. The following hypothesis is introduced, analyzed and ultimately rejected: that the Trolley Problem can be used to distinguish between the supposed ethical permissibility of lifting lockdowns and the supposed ethical impermissibility of pursuing herd immunity during the COVID-19 pandemic. The aim of the chapter is twofold: both to test whether and how far we can progress within pandemic ethics by using the Trolley Problem and also to test whether the particular case of the COVID-19 pandemic can make a methodological contribution to trolley debates in philosophy.

The goal of Chapter 5 is to respond to a long-standing objection to the PDE known as the closeness problem. The problem is supposed to arise because intentions are sufficiently fine-grained that an agent need not intend harm in nearly any situation. The PDE therefore fails to rule out conduct that is intuitively objectionable in a host of cases unless it is supplemented with a criterion of excessive closeness, whose role is to identify things that are “too close” to harm to be considered incidental for purposes of double effect. However, it also proves extremely difficult to specify a criterion of closeness that is not arbitrary or subject to counterexamples. The closeness problem is often thought to be particularly acute for Anscombe-style accounts of intentional action, such as the one I presented in Chapter 4. I argue, however, that the magnitude of the closeness problem has been exaggerated and that the PDE does not need to be supplemented by a criterion of closeness.

Chapter 3 develops a theoretical grounding for the PDE, the solidarity rationale. Taking a cue from Philippa Foot, I situate the PDE within a larger region of morality, one structured around the concept of solidarity. I propose that our conduct is measured by a standard of human solidarity toward each other person, that is, a standard of concern and goodwill that is based on our common humanity, and that a person’s conduct is wrong when it deviates from this standard. I argue that the solidarity standard grounds more specific moral norms, including the precept of beneficence, the strict constraint against intentional harm, and the Principles of Proportionality and Due Care. Finally, I argue that the normative foundation for the solidarity standard is the dignity of human beings.

In Chapter 7, I argue that the solidarity rationale for the PDE from Chapter 3 enables a response to Joshua Greene’s argument that findings from empirical psychology debunk deontological constraints on causing harm. Greene’s deontological debunking argument is based on the dual-process theory of moral judgment, and I begin by reviewing the main elements of this theory. Next, I describe the two stages of Greene’s debunking argument. Stage 1 aims to debunk the case-based intuitions that seem to support deontology over consequentialism, while Stage 2 aims to debunk deontological normative ethics. I argue that Stage 2 of Greene’s argument is unsatisfactory, and I explain why it fails to undermine the solidarity rationale for the PDE. Finally, I outline two possible explanations of why our case-based intuitions should be sensitive (even if imperfectly) to a feature of conduct – intentional harm – that is morally significant.

An agent who acts intentionally typically foresees that she will bring about a number of effects and that her conduct will fall under a variety of different descriptions. Which of these effects and descriptions are intentional and which are incidental? To answer this question, Chapter 4 presents an Anscombian account of intentional action. I first show how Anscombe uses a special sense of the question “Why?” to elucidate the teleological order characteristic of intentional action. I then explain how the teleological order of an agent’s intentional action is determined by the calculation on the basis of which she acts, where the concept of calculation is illuminated by the notion of practical reasoning. Next, I explain how Anscombe’s account of intention and intentional action differs from a false conception she calls “Cartesian psychology.” Finally, I apply the Anscombian account to three controversial cases.

One way of motivating the PDE is by appealing to our intuitions about cases. We might wonder, however, whether there is any deeper rationale for the principle. In Chapter 2, I argue that proponents of double effect face the grounding challenge: The challenge of providing a theoretical rationale that explains why the distinction between intentional harm and incidental harm is relevant for evaluating the moral permissibility of human conduct. I first show how the PDE accounts for common intuitions about a number of cases that might otherwise seem puzzling. Next, I provide four reasons why the PDE cannot be sufficiently justified solely on the basis of its agreement with case-based intuitions. I then examine six proposed rationales, and I argue that each is vulnerable to serious objections. The thrust of the discussion is therefore critical, but at the end of the chapter, I draw some lessons from the failures of these proposals. This sets the stage for Chapter 3, where I turn to the constructive project of developing a novel rationale.

According to the PDE, there is a strict moral constraint against bringing about serious evil (harm) to an innocent person intentionally, but it is permissible in a wider range of circumstances to act in a way that brings about serious evil incidentally, as a foreseen but nonintended side effect. In Chapter 1, I discuss the key terms in this definition and I distinguish between an absolutist version of the PDE and a nonabsolutist one. I then introduce two principles that help guide agents when they foresee their conduct will cause incidental harm: the Principle of Proportionality and the Principle of Due Care. Finally, I describe the role of the PDE in just war theory and international humanitarian law, and I set out the plan for the remainder of the book.