Several recent high profile euthanasia-related cases have again highlighted the ethical concept of intention. Drs Irwin and Moor announced last July that they had assisted in the deaths of 50 and 150 patients respectively, and gave as reason for these admissions desire to draw attention to what they see as the hypocrisy of doctors giving doses of narcotics which may shorten life, allegedly hiding behind the (unhelpfully named) 'doctrine of double effect'.

Motor neuron disease patient Annie Lindsell went to the High Court, ostensibly to seek clarification of the law, asking that high doses of diamorphine could be used for symptoms of 'distress', as well as for the traditionally accepted symptom of pain. The case was withdrawn after the diamorphine regime her doctor wanted to employ was negotiated downwards very considerably to a level standard in palliative care, and which could not have the intention to kill.

It was obvious from the media that many, some professionals included, did not understand the concepts involved. The concept of intention is quite simple. Intention is about purpose - 'What did the health professional mean to do when she performed the act? What did she mean to do when she omitted to act?' Intention speaks to the head; motive speaks more to the heart - 'Why was that her intention? What thoughts were going through her mind?'

Intention is a long-accepted concept in British law and ethics, and it comes from the Bible. In the Old Testament, 'cities of refuge' were arranged for those who had committed manslaughter rather than murder: 'he killed his neighbour unintentionally and without malice aforethought'[1]. This distinction, which centres on the importance of intention, remains foundational in British law on homicide.

Lay people intuitively accept that what you meant to do matters. Why do those moral philosophers who have such influence in healthcare ethics today have so much trouble with the concept? They claim that intention is of no moral relevance, only the outcome matters. Thus for them, the ethics of the death of a cancer patient are the same, whether the patient was despatched by lethal injection from a euthanasiast doctor or whether pneumonia ('the old man's friend') was (perhaps rightly) left untreated so that the patient's life came to a natural end. The outcome was the same, so there was no significant moral difference in the behaviour of the doctor in the two situations.

Intention squares with the intuitions of most of us, particularly those who believe in a God who judges our hearts, so why do the philosophers have such a problem? Could it be that they believe 'there are no absolutes'?

Incidentally, is that an absolute statement? If it is an absolute statement, then there is one thing in the whole of the universe which is an absolute - that statement - and it is therefore shown to be untrue. Or is the statement not an absolute one? In which case, there are some absolutes. Either way, the statement is absurd, but that hasn't stopped it being recited by expert ethicists in the media.

It is time both in ethics and in everyday life we nailed this particular lie. Intention does matter. God judges partly on the basis of it. So may the law of the land. No patient requires to be killed intentionally by act or omission as part of their healthcare.

So, in deliberately trying to engineer confusion about this very clear concept, euthanasiasts and others, what's your intention?