Some people are skeptical of distinctions between doing and refraining. It seems that anybody who accepts classical double effect reasoning must accept such a distinction.
Suppose you’re informed that if you don’t kill Alice, then Bob and Carol will be murdered, with all three innocent. The double effect reasoning says you may not kill Alice, since even if you are aiming to save Bob and Carol, the means to saving Bob and Carol is Alice’s death, and so you would be intending to kill Alice.
But suppose we don’t make a distinction between doing and refraining. Refraining from killing Alice has Bob and Carol’s death as a consequence. But this consequence is disproportionately bad, so by classical double effect reasoning, you are prohibited from refraining to kill Alice. Hence, killing Alice is wrong but so is refraining from killing her. Thus, this is a case of a real moral dilemma. But everyone who accepts classical double effect reasoning denies that this is a moral dilemma: you simply shouldn’t kill Alice, and then you’re doing nothing wrong.
So it seems that double effect cannot apply to both doings and refrainings equally. Thus, it seems that the right solution to the above problem is to say that double effect applies only to doings.
But there are cases where one might think double effect reasoning applies to refrainings as well. To adapt Rachels’ famous case, suppose innocent Tommy is drowning in a bathtub, and you can easily pull him out. But you’ve been informed that unless Tommy is dead by the end of the day, Bob and Carol will be murdered. Because it’s wrong to kill Tommy by double effect for doing, you were steeling yourself to accept Bob and Carol’s death. But now things have changed. Now it seems that double effect forbids you to save Tommy, because a consequence of saving Tommy is the death of Bob and Carol, and that’s disproportionate.
I am very unclear on this case. But maybe the judgment that you are forbidden to save Tommy is correct. Consider this case: you see someone drowning, and you could rescue them, but then someone points a gun at two hostages and informs you that if you save the drowning person, the hostages will be killed. Then you really should refrain from saving the drowning person.
