.
The conflicts of duties, both positive and negative, in each case are weighed against each other in a way which makes some actions (e.g. doctor withholding the scarce drug from patient) right, while others (e.g. harvesting a healthy patient's organs) are wrong. In this case, there is clear difference between the duties faced by both doctors given the circumstances. Foot describes the actions of the doctor who withholds medicine from one patient as "weighing aid against aid," meaning that in deciding whose life will be spared by the scarce drug, the doctor is not intentionally killing anyone by choosing one or the other. Rather, the doctor is faced with two positive duties of bringing aid, and rationally chooses the duty which brings the most aid. The "double effect" of this decision results in the death either one or five, but it is important to note that their deaths are not caused by any direct killing on the doctors part, instead it occurs as a side effect of the doctors inability to bring aid. .
In considering the other related scenario, the doctors decision to sacrifice one innocent person for the lives of five others involves a positive duty of bringing aid and a negative duty of not inflicting injury. In cases where both positive and negative duties are weighed against each other, there is more of an obligation to act in the interest of fulfilling negative duties than it is to promote positive duties. Therefore, it would be wrong for the doctor to act in the interest of bringing aid to someone, even if it is five people, if it means that he will fail in his negative duty to refrain from inflicting harm. This case is distinct from the previous one because the perfectly healthy patient did not require the same positive duty of aid as the other patients did, meaning that he did not face the possibility of death and the doctors choice to kill him would be morally impermissible.
