oxford handbook of bioethics

122 DA N I E L P. S U L M A S Y

Definition 5: Conditions of fulfillment. Searle (1983: 14) notes that as propositions have truth conditions, so intentions have conditions of fulfillment. If an event comes about in the way the agent intends it, the agent’s intention has been fulfilled.

Definition 6: Prior intentions. To have a prior intention means that an agent has consciously chosen to bring about an event (i.e. an end) in advance of an act. When fully mature, this prior intention also includes a choice of a means of bringing about the intended end. When complex, this prior intention includes all those (generally multiple) cause and effect relationships that are part of the agent’s plan.

Definition 7: Intention in acting. To have an intention in acting means that an agent has acted or is acting, and that one can ascribe to the agent’s act the choice of a complete act — both an end and a means of achieving that end.

Definition 8: Further intention. To have a further intention means that the agent intends to act upon a complex prior intention that includes not only the immediately intended event, but also some further event that the agent has chosen as part of her plan.

Intentional Causation

Causation is itself a vexatious philosophical topic. For the purposes of this chapter, however, all that is required is an intuitive grasp of what is meant by causation. The theory of intention that I present should be compatible with almost any theory of causation one would choose to believe.

Agents act in the world. Acts are, as defined above, those events that take place in the world that are explained by the intentions of agents. Agents cause events in the world by way of their intentions. Precisely how this comes about is beyond the scope of this chapter, but it is a great marvel that the events we call acts are causally explained by way of the intentions of agents.

Yet one can be more precise. Acts are causally explained by the propositional content of intentional choices that must refer to some agent’s intention in acting (Searle 1983: 85 ff.; Donagan 1987: 88). Acts are events that are explained when the conditions of fulfillment of the intention of an agent are realized by way of the agent himself or herself carrying out that intention. There is a necessary self-referentiality to one’s intentional causation. Thus, not everything that happens after an agent acts can be explained as having been intentionally caused. While an agent may have caused events other than the condition of fulfillment of her intention, properly speaking, these other events are not part of the agent’s act. Ethically speaking, events that are not properly part of the agent’s act are evaluated differently from those that are.

For example, suppose that Tim should intend to write Diane a prescription for 2 grams of secobarbital so that she could commit suicide, and were to have told her that this was his intention. Suppose that he were to have written a prescription

for Debbie for 2 grams of secobarbital, but had not yet written the prescription for Diane. Now, suppose further that Diane were to have shown up at Tim’s office, seen the prescription for secobarbital written for Debbie, thought it was for her, had it filled, consumed all the pills, and died. It would be true that Tim’s intention caused Diane to die, but it would not be true that Diane’s death could be explained as having been intentionally caused by Tim. Her death did not come about by way of Tim’s acting upon the full propositional content of his actual intention. If the district attorney were to investigate him as the agent of Diane’s death, he would need only to show that the prescription that Diane filled was written for Debbie, and the charges would be dropped.

Agents need no theory of causation in order to act, but agents grasp the causal potential of their intentions. The plans that agents make often involve complex causal paths. As I shall explain in greater detail below, if an agent has formed a complex prior intention that includes further intentions as part of a plan, the conditions of fulfillment of that complex prior intention include all of the events that are foreseen as causally required in order to fulfill the furthest intention in that plan. As I will explain in greater detail later in this chapter, this is why conditions (g), (h), and (i) of Requirement 7 of the Reformulated RDE are so important. They address the agent’s intended causal chain, not merely the agent’s intended results.

For example, if Jack intends that Janet should die by way of her pushing a button that causes a programmed series of injections of drugs that will first cause her to be sedated, then cause her to be paralyzed, then cause her heart to stop beating, and thus cause her death, the condition of fulfillment of Jack’s intention is that Janet’s death should come about by way of his having that complex prior intention — a complex prior intention that includes all of the causally necessary conditions for her dying in just this way.

The Irreducibility of Intention

Knowing something about what one means by intentional causation still does not ensure that one has adequately understood what an intention is. Understanding intention as a propositional attitude raises questions about the relationship between intention and other propositional attitudes. It became common in the twentieth century, under the influence of positivism and behaviorism, for many philosophers to hold that intentions were reducible to beliefs, desires, or some combination of these other propositional attitudes. Against this, Aristotle (1985: 1111b12) wrote that, ‘Those who say decision is appetite or emotion or wish or some sort of belief would seem to be wrong.’ Contemporary philosophy of action now holds that Aristotle was correct.

Donagan takes an Aristotelian position and argues that the propositional attitude of intention cannot be reduced to any other propositional attitude. And he and

124 DA N I E L P. S U L M A S Y

others have amassed a significant array of arguments to make it clear that while certain beliefs and desires might be relevant to an intention, no combination of belief and desire is sufficient to account for an intention.

While intentional acts require a whole nexus of background beliefs, intention cannot be reduced to belief alone. There are several reasons for this. First, beliefs alone, as Brand (1984: 94 – 7) points out, cannot initiate acts the way intentions can. For example, Tim’s belief that he will write a prescription for a lethal dose of secobarbital for Diane is not sufficient for him to act on that belief, nor would it be sufficient to explain his so acting if he were to write such a prescription. No matter how strong his belief, the act will not take place unless Tim is moved to do so, and a belief is not a being-moved-to-act.

Second, Searle (1983: 3) simply points out that the ‘direction of fit’ differs in intention and belief. Belief has a ‘mind to world direction of fit’. That is, the truth conditions for beliefs involve the conforming of the believer’s mind to the world. On the other hand, intention has a ‘world to mind direction of fit’. The conditions of satisfaction of intentions involve the world coming into conformity with the agent’s mind. Given this fundamental asymmetry between intentions and beliefs, it is hard to see how one could be reduced to the other (Searle 1983: 9 – 10).

Finally, it does not seem necessary for an agent to believe that the intended outcome of an intentional act will be accomplished by the act. It would seem that one can very strongly intend what one believes one will not accomplish, and there is nothing illogical about this. One can intend what one does not believe will happen. For example, one could intend to withstand torture even if one were to believe that the overwhelming likelihood were that one would eventually crack (Gustafsen 1986: 68). Similarly, a doctor could intend to save a patient’s life and act accordingly even if she were to believe that this would be, to a reasonable degree of medical certitude, impossible. One can intend to do either what one believes one will accomplish or what one believes one will not accomplish.

Intentions Are Not Desires

Neither can intentions be reduced to desires (Anscombe 1969: 5 – 6). It is certainly true that desires have the same direction of fit as intentions, directed towards the conforming of the world to the mind of the agent, and this may have led certain thinkers to try to account for intention solely on the basis of desire. But having the same direction of fit does not mean that desire and intention are the same. Desire is neither necessary nor sufficient for intention (Brand 1984: 122 – 3).

First, equating intention with desire makes accounting for the problem of wayward causal chains an insoluble problem (Gustafsen 1986: 44). The fact that something an agent desires actually comes to pass in no way implies that its occurrence was intentional. Suppose that Tim desired to give Diane the knowledge

and the means to commit suicide. Suppose that he had discussed this with his postdoctoral fellow, a young and enthusiastic general internist. Suppose that, while Tim was off giving a lecture about assisted suicide, Tim’s postdoctoral fellow were then to write a prescription for an overdose of secobarbital and were then to give it to Diane along with instructions on how to use it. If Diane were then to take the overdose, would one say that her death was intentional on the part of Tim simply because he desired it? Hardly. And if that is the case, how could one say that what happens intentionally is what one desires to happen and actually comes about?

Second, it seems clear that one can easily intend what one does not desire, and that one can desire what one does not intend (Brand 1984: 122 – 3). My desire to eat ice cream does not mean that I intend to eat ice cream. At the moment, I have a strong desire to eat ice cream. I enjoy it very much. But I do not intend to eat ice cream. In the short run it would ruin my appetite for dinner. In the long run it would contribute to the ruin of my arteries by clogging them with cholesterol-rich atherosclerotic plaques. And because I think it would be noble to set a good example for my patients (whom I instruct to refrain from eating ice cream), I overrule my desire for ice cream and do not intend to eat it. Similarly, I often intentionally do what I do not desire to do. I frequently do not desire to stay at the office and see patients who show up late and happen to be very sick and in need of immediate medical attention. This is particularly true when my colleague who is supposed to be on call for such emergencies can’t be reached and I have had to stay late and have missed supper the two previous nights in a row and the patient who has shown up late but very sick has not followed my instructions and has a habit of showing up late and I have a tennis court reserved and love to play tennis. Despite my desires to the contrary, I act intentionally in staying with the patient and providing the necessary care. Intention cannot be reduced to desire alone.

A frequent response to such arguments is to say that there is no such thing as an intention contrary to desire. On this theory, one really always does what one desires the most in any given situation. In the example given above, it can be argued, the desire to eat ice cream is simply not as strong as the desire to enjoy dinner or to maintain cardiovascular health or not to appear hypocritical to my patients. In the other example, it might be said (charitably) that my desire to help patients or (less charitably) my fear of a malpractice suit are my predominant desires and that I simply desire these more than playing tennis.

But this argument can be dispensed with on several grounds. First, one must note that this begs the question in a serious way. If one has presumed that there is no such thing as an undesired intentional act, one simply reinterprets every other kind of explanation of an act as a disguised desire.

Second, as Bratman (1987: 19) points out, even the postulation of such a predominant desire ‘does not guarantee that my desire will control my conduct’ the way that it seems an intention would. For example, Tim may begin an office

126 DA N I E L P. S U L M A S Y

visit with Diane feeling as if he can offer her no more help except by giving her the knowledge and the means to commit suicide and may have a predominant desire to do just that: to help her commit suicide. But this does not mean that he has settled upon giving her the means and the knowledge, nor has he settled on a plan for doing so (like a prescription for secobarbital). He still might not be sure that he will do so. He might also have a desire to make a breakthrough in the quality of medical care by launching a national campaign for assisted suicide and might see this case as a possible test case for his idea. But he might see his acts as constrained by certain principles. Tim might think that he would not assist Diane in suicide if she had relapsed in either her alcoholism or her depression, and so might not have formed an intention to write the lethal prescription and give the lethal instructions before talking to her, even though he might be quite desirous of doing so. This is not to say, of course, that intentions could not be formed on a provisional basis and later reconsidered. Bratman (1987: 5) is only arguing that intentions can constrain behavior even in the face of a dominant desire.

Third, most of the examples of a conflict between desire and intention involve the concepts of duty and external coercion. As Brand (1984: 123) points out, in these conflict situations it is simply not the case that doing one’s duty or giving in to external pressures is equivalent to desiring what one does not desire. Brand gives the example of Richard Nixon resigning as President. Nixon could not truly be said to have resigned because he desired not to be impeached more than he desired to remain in office. Nixon’s predominant desire, one supposes, was to remain in office more than anything else. Yet his resignation was an intentional act.

Or suppose that I desire that my patient should die. Suppose she has widespread metastatic cancer of the breast, is suffering great pain that is mostly, but not completely, relieved by medication, but that this incomplete pain relief had to come at the price of being sleepy most of the time. I might very well desire that she should die quickly, thinking that this would be for the best. I might even pray for her quick death. I might come to consider her death my predominant desire. But it seems clear that, even though I might strongly desire that she die, this does not mean that I intend that she should die. This desire would make my decision morally difficult, to be sure. If I were to believe that I had a duty not to practice euthanasia or assisted suicide, I would need to act against my desires. But I can do that. Intentions can override desires. And one can take this as evidence that desires are not intentions.

To see why the reduction of intention to desire is so conceptually problematic, it might help to examine the problem of the ‘package deal’. Most choices made in cases of conflict can be regarded as choices of ‘package deals’. On the theory that intention can be reduced to a predominant desire, one would be forced to say that the choice of such a package deal implies that, on the whole, this ‘package’ is what the agent most desires. Consider again the case above regarding the physician who gets stuck late in the office caring for an acutely needy patient. On the theory that intentions can be reduced to predominant desires, one would say that the agent’s

128 DA N I E L P. S U L M A S Y

Choice requires something that desire alone cannot supply — namely, intention. The nature of tragic choice and the moral life requires that intentions not be reduced to desires.

Intentions, by contrast, do not logically distribute over conjunctions of events. To intend (A and B) does not imply that one otherwise intends A and otherwise intends B. Sophie’s choice of this conjunction does not imply, logically, that Sophie, other things being equal, otherwise intends that child A should live and otherwise intends that child B should die, any more than my choice to stay in the office and not play tennis implies that, other things being equal, I otherwise would intend to stay in the office and otherwise would not intend to play tennis.

Intention cannot be reduced to desire because intention involves a commitment of some sort — a choice. And choices are often hard. They sometimes involve doing what one does not desire. A choice is, as Donagan (1987: 51) would put it, a fully determinate intention.

In addition, it seems simply implausible that doing one’s duty should always be doing what one most desires, even for a saint. If a duty is a real duty, it would seem that it should be capable of constraining desire. And this would cast further doubt on the notion that intention can be reduced to desire.

Further, as both Searle (1983: 103) and Brand (1984: 124) point out, desires can be contradictory while intentions cannot. For instance, Jack can desire that he should euthanize Thomas and also desire that he not transgress the law by doing so. But presuming that he is fully informed about the law and understands that euthanizing Thomas would break the law of the State of Michigan as it stood in September 1998, then he cannot intend to euthanize Thomas in the State of Michigan in September 1998 without intending to break the law.

Brand (1984: 124) also points out that desires admit of degrees, while intentions do not. For instance, one can say of Tim that he greatly desires to help Diane commit suicide, but it makes no sense to say that he greatly intends to help her commit suicide. Intention requires, as Davidson (1980: 101) once put it, an all-out judgment. Intentions do not admit of degrees the way desires can. Intentions are not reducible to desires.

The Belief – Desire Model is Inadequate

The most sophisticated model proposed by those who are not convinced that intentions actually exist is the belief – desire model. Such a model suggests that a combination of belief and desire accounts for intention. A good example of this approach is given by Faden and Beauchamp (1986: 242 – 8). By their account, a surgeon who desires to operate on a patient, believing that it is possible to operate and believing that it is possible that he will scar the patient, intends to operate on the patient and intends to scar the patient. While I suspect most surgeons would

find it perplexing to be told that they intend to scar their patients, for Faden and Beauchamp, nothing more need be said.

But no such combination of beliefs and desires will accomplish what neither belief nor desire alone could do — account completely for intention. There are several reasons for this.

First, Searle argues that while intentional states may involve belief and desire, intentionality is not reducible to belief and desire. For example, to be annoyed that p, to be remorseful that p, and to be sad that p all imply the belief that p and the desire that not-p. But annoyance, remorse, and sadness are not the same. Likewise, the fact that intentions might involve belief or desire does not imply that intention can be reduced to belief and desire (Searle 1983: 35 – 6). Second, the arguments made above point out that desire is not merely insufficient, it is in fact unnecessary to account for intention. If belief is insufficient and desire is unnecessary, then no combination of belief and desire will be both necessary and sufficient to account for intention.

Third, as Aquinas pointed out long ago (Aquinas 1964: I-II q. 13 a. 6 ad 3), human agents are not paralyzed by equal choices. When one is faced with choices that are equally desirable or undesirable and one believes that both choices are available and can be achieved with equivalent effort and equivalent satisfaction of one’s desire, one is still able to choose between the two courses of action. Intentional choice is something over and above belief and desire.

Bratman (1987: 11 ff.) makes the same point by discussing a set of problems known as Buridan cases (see note 14). If one sits before two equally desirable boxes of cornflakes believing that eating either will satisfy one’s desires equally, and believing that one will satisfy one’s desire by eating cornflakes and believing that it is equally likely that either box could be obtained with equal convenience and equal success, has one thereby formed an intention? Does one thereby intend to eat either box of cornflakes? Both boxes of cornflakes? It hardly seems so. Belief and desire do not add up to intention.

It is important to note that the foregoing does not mean that one cannot simultaneously desire and intend that the same event should come about, or that one cannot simultaneously believe and intend the same event, or that one cannot simultaneously desire, believe, and intend the same event. Nor should the foregoing be taken as an argument that only intentions matter in morality, and that beliefs and desires do not matter or that consequences do not matter. On the contrary, moral agents can have multiple propositional attitudes towards the events they bring about intentionally, and a robust philosophical moral psychology will have something to say about all of these propositional attitudes. Intention is important, but morality is not limited to intentions. All I have tried to establish is that intentions cannot be reduced to desires and beliefs and that intentions have a special importance in the evaluation of the acts human beings undertake.

130 DA N I E L P. S U L M A S Y

Intentions Are Not Motives

Neither should intentions to be confused with motives. A criminal investigation of homicide provides a good example of the difference between intention and motive. When the police look for a motive for a fatal knifing, or for a suspect with a possible motive, they have often already assumed that the act was intentional. They generally presume, that is, that the stabbing was the ascribable condition of fulfillment for the suspect’s intention in acting, and they often believe that the death of the victim by way of the suspect himself stabbing her was the condition of fulfillment of the suspect’s mature complex prior intention. When searching for a motive, however, they want to know what could have initiated or led someone to perform such an intentional act. As Davidson (1980: 105) puts it, a motive is a reason for intending. Gustafsen (1986: 181 – 2) agrees, pointing out that motives start intentions.

However, ordinary language sometimes confuses motives with what I have called further intentions. Anscombe (1969: 20 – 1) distinguishes backward-looking motives from forward-looking motives. She means by a backward-looking motive that the main ground of the motive is something that happened in the past, or is happening now. By contrast, the main ground of a forward-looking motive is something that has yet to take place. It is forward-looking motives that are most easily confused with intentions.

As an example of a backward-looking motive, one might be seeking to understand the motive for a person’s suicide. If the person’s motive were to ‘get even’ with those who had failed to show adequate concern for her suffering — to cause them suffering in return by making them feel guilty — it would be a backward-looking motive. Revenge is something that gets started by something in the past. One can look forward to the day of revenge. And the revenge would be present in the suicide, but it would have started because of past events. The memory of past hurts to the person committing suicide and a desire to respond by returning the hurt would be the complex state of affairs that constitutes the motive.

By contrast, a person might commit suicide to prevent some undesired future state of affairs. This would be a forward-looking motive. For example, Janet might fear that as a carrier of the -4 allele of Apolipoprotein E, she is at such high risk for Alzheimer’s disease that at the first signs of memory loss she would rather commit suicide than face further dementia. If this were her motive for committing suicide, it would be forward-looking.

While ordinary language can be sloppy in this regard (especially regarding forward-looking motives) a motive is not some further desired event. Death is what Janet intends, but death is not her motive. Her motive might be fear, or embarrassment, or some other psychological state regarding her future. Anscombe also names admiration, spite, and friendship as forward-looking motives, but these attitudes or states of affairs are not events that could function as the objects of genuine intentions. A motive is a psychological state of affairs that helps to explain

how an agent comes to have an intention. Properly speaking, the propositional content of an intention must refer to an event. Intentions and motives are not the same.

Event Identity

Thus far, I have explained what intentions are and how they differ from beliefs, desires, and motives. However, merely establishing that intentions are not reducible to beliefs and desires does not suffice for establishing a plausible distinction between the foreseen and the intended. Certain beliefs must necessarily be ascribable to the agents that undertake acts. Those beliefs must be coherent and plausible if the description of the agent’s intentional state is to be coherent and plausible. Intentions, by definition, explain the events brought about by agency. So, while intention cannot be reduced to beliefs, incoherence or implausibility in an agent’s beliefs about the events that she brings about can render her explanation of those events as having come about under a particular intentional description incoherent or implausible.

Critical to any proposed account of the distinction between the intended and the foreseen are beliefs regarding descriptions of events. Especially crucial is the question of whether two or more particular descriptions describe the same event or different events. With this in mind, I will propose a definition of event identity. This definition is modified somewhat from Myles Brand’s work. I will suggest that, formally,

Definition 9: Event identity. If ‘x’ and ‘y’ are descriptions that pick out events, then if x and y occupy the exact same spatiotemporal coordinates, ‘x’ and ‘y’ pick out the same event.

This means, for instance, that if x is an event (described, say, as ‘Oedipus marries Jocasta’) and y is an event (described, say, as ‘Oedipus marries his mother’) and both of these events occupy the same spatiotemporal coordinates, then they are the same event. ‘x’ and ‘y’ may be two true definite descriptions, but both descriptions pick out the same event.

Conditions of Plausibility and Coherence: Distinguishing the Intended from the Foreseen

Armed with the philosophy of action I have just outlined, I can now specify a set of conditions that will permit one to test whether any particular report of a distinction between the intended and the foreseen is plausible and coherent. This, I believe, has always been the purpose of the causation requirement of the classical formulation of the RDE (Requirement 3 in Mangan’s formulation). In fact, if one is rational