Double effect implies that grave harms foreseen as side effects may be permissible even when grave harms intended as means are not

Nevertheless, many criticisms of the principle of double effect do not proceed from consequentialist assumptions or skepticism about the distinction between intended and merely foreseen consequences. Instead they ask whether the principle adequately codifies the moral intuitions at play in the cases that have been taken to be illustrations of it. One important line of criticism has focused on the difficulty of distinguishing between grave harms that are regretfully intended as part of the agent’