When Doing the Right Thing is Impossible by Lisa Tessman (review)

Lisa Tessman's When Doing the Right Thing is Impossible offers an engaging and accessible exploration of the complex philosophical issues surrounding moral dilemmas and moral failure. Are there genuine moral conflicts? Is it true that in some situations a moral agent cannot help but fail? Tessman offers her own answer–yes, in some situations, moral failure is unavoidable–while guiding readers through the debates surrounding these questions, clarifying the various positions sympathetically and carefully.

Part of what makes the book so immediately gripping is the case study it begins with in Chapter One: Tessman focuses on the case Memorial Medical Center in New Orleans during Hurricane Katrina. During the storm, the hospital was full of patients as well as a number of community members, off-duty staff and their families who were seeking shelter. In the aftermath, the hospital was seriously compromised—the air conditioning stopped working, the water became unsafe to drink or wash with, toilets stopped working, and medications ran low. Some critically ill patients were evacuated by helicopter, but many more were not. As time went on, exhausted staff and volunteers made mistakes, and doctors and administrators made pressured judgment calls, including the decision to go into lockdown and post armed guards to keep out desperate people (seen as potential looters) trying to get in. After being trapped in the hospital for four days, the backup generators failed and the situation worsened further. Staff, nurses, and doctors acted heroically: they pumped oxygen by hand for patients who had required ventilators, and designed IV drips that would not require electricity. But, in desperation, they began to make decisions about who would most deserve evacuation, now with a plan to leave those who were either most sick and therefore least likely to survive evacuation, or too large and unwieldy to move, for last. When it became clear, given complex and horrifying circumstances, that not everyone would be evacuated, according to some accounts, some doctors and nurses gave injections of morphine and other drugs to hasten the deaths of those who would not be.

The question Tessman raises from this case is the one at the heart of the book: are there situations in which what agents are morally required to do is something that is impossible to do? As in the case of the doctors and nurses, we might think they were both morally required to not [End Page E-15] leave patients in the hospital to suffer and die, and at the same time that deciding to give patients who might survive a drug to hasten their deaths was morally reprehensible. Or, put differently, we might think they were morally required to save their patients but also that saving their patients was impossible—they were morally required to do something they could not do. Giving a philosophical account of how this can be the case is complicated, given some fundamental commitments that shape much of philosophical ethics. For one thing, as Tessman notes, if we agree with her that there can be impossible moral requirements, then we must be willing to contradict the Kantian principle "ought implies can" (Tessman 16).

Chapter two takes up the question of whether moral dilemmas can in fact exist. Tessman distinguishes moral conflicts (i.e., situations in which there is a moral requirement to do both A and B and one cannot do both A and B) from moral dilemmas (i.e., situations in which there is a moral requirement to do both A and B, one cannot do both, and neither ceases to be a moral requirement as a result of the conflict). In the case of dilemmas, even if an agent judges that moral requirement A overrides moral requirement B, B does not stop being a requirement. Failing to do B, even in order to successfully do A which the agent judged to be more important, would still be a moral failure. As Tessman notes, many philosophers believe that moral dilemmas do not exist. She canvasses two "anti-dilemma" philosophical positions: those who...