Experimental philosophy, clinical intentions, and evaluative judgment.

Recent empirical work on the concept of intentionality suggests that people’s assessments of whether an action is intentional are subject to uncertainty. Some researchers have gone so far as to claim that different people employ different concepts of intentional action. These possibilities have motivated a good deal of work in the relatively new field of experimental philosophy. The findings from this empirical research may prove to be relevant to medical ethics. After all, the intentions of medical professionals are widely considered to be important in the ethical assessment of their actions. For example, in the debate over palliative sedation for terminally ill patients, it is often said that it is permissible for a clinician to administer a potentially lethal dose of pain medication to a patient, provided that he or she by doing so intends only to relieve the patient’s suffering and does not intend to kill or hasten the death of the patient. This idea—that it can be permissible to bring about a foreseen but unintended effect (the patient’s death), although it would not be permissible to intend to bring about this same effect—is central to the principle of double effect (PDE), which has found expression in both the law and the professional codes of medical organizations. Notwithstanding this point, over the past decade or so, a number of writers have challenged the value of focusing on the intentions of clinicians when considering questions of ethically permissible conduct. They have claimed that clinical intentions are often equivocal and multiple. They also have claimed that clinicians frequently have difficulty identifying what their intentions are in a given case. In light of the importance that intention plays in medical ethics, it is surprising that no research has been done to identify causes or psychological factors that might help to explain this uncertainty over intentions in clinical reasoning. In this article, we address this issue head on. We first describe a study we conducted on intention ascription. Drawing on recent work in experimental philosophy, we investigated the possibility that the ascription of intentions to clinical actors in clinical settings is influenced by prior judgments about the goodness or badness of the consequences of the action in question. Our study was modeled on experimental studies in other contexts that have shown that people, when presented with a range of scenarios, are more likely to classify a side effect of an action as intended if the side effect is negative or reflects poorly on the actor than if it is positive or reflects well on the actor. We investigated whether this asymmetry in intention ascriptions was also present among physicians who were asked to ascribe intentions to clinical actors in certain well-defined clinical scenarios. After describing the study and its results, we discuss its implications for medical ethics.