Editorials When doctors might kill their patients

Foreseeing is not necessarily the same as intending

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7196.1431 (Published 29 May 1999) Cite this as: BMJ 1999;318:1431

And the difference is crucial for patients and their doctors

  1. Raanan Gillon, Professor of medical ethics
  1. Imperial College School of Medicine at St Mary's, London W2 1PG

    Following the acquittal of an English doctor, Dr David Moor, who had given a dying patient a lethal dose of diamorphine, we invited two ethicists to debate the issue at the centre of the case: that of giving a drug with the intention of relieving suffering even though it may hasten death. Professor Raanan Gillon argues that the difference between intending and foreseeing is all important, while Professor Len Doyal argues that the effect of this is to raise the moral character of a clinician above the best interests of his or her patients

    Like many other general practitioners I breathed a sigh of relief when Dr David Moor was acquitted of murder earlier this month.1 Like him and many other doctors, I too have given a patient intravenous heroin intending to relieve his distress but foreseeing that my action might hasten death. Yet some argue—often passionately—that there is no difference between (a) my foreseeing that my action may kill my patient and my patient then dying and (b) my intending my action to kill my patient and my patient then dying. If the court believed that there was no difference then I, as well as Dr Moor and countless other doctors, would be murderers. I argue that a and b are different logically, experientially, conceptually, legally, and …

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