Alice and Bob are a married couple, but the marriage is not a happy one. Bob is controlling and emotionally abusive. Alice “takes it”, but she is secretly resentful and filled with rage.
One day, Bob is diagnosed with an illness that is easily controllable with medication. His doctor told him he could die from this illness, but Bob feels fine and is very noncompliant with his meds. Alice is aware that he’s not taking his meds, and keeps her mouth shut. Doesn’t remind him to take them, or encourage him, or anything. She does fantasize about being free.
So, one day, Bob drops dead.
How culpable is Alice?
My thoughts: Up to the bolded sentence, it depends on a few factors:
(1) Does Alice know that the illness will be fatal without medication?
(2) In what way is Bob abusive?
(3) Is she keeping silent because she fears retaliation? Does she expect physical retaliation?
If the answer to (1) is no, and her ignorance is invincible, then Alice is not culpable. (The bolded sentence suggests that she suspects that answer to (1) is yes, however.)
Assuming the answer to (1) is yes, then I would judge that by the principle of double effect (proportionality criterion), Alice could only remain silent without being culpable if Bob were, say, physically abusive and would retaliate if she said anything about his medication to him. If he would be rude to her, for instance, but she knows that neglecting his medication could kill him, then she is still culpable for remaining silent. The good (her emotional comfort) does not justify the unintended evil (Bob’s potential death).
That is all disregarding the bolded sentence, which implies that her omission is accompanied by an intention for Bob to die. Taking the bolded sentence into account, Alice is culpable for Bob’s death, and that is even true if talking to Bob is physically threatening to her. (You seem to imply that Bob is not physically threatening, just emotionally abusive. So in the description of the situation you have given, I regard Alice as culpable. The context of their marriage is in this case not really relevant.)
One might say that willing to be free of Bob and willing for Bob to die are not the same thing. But intentions are not so easily detachable in practice, and it seems to me that Alice’s intention is evil, first because it seems plausible that willing Bob’s death is a part of willing her freedom (in this case)*, but also because she knows that she will obtain her freedom by means of the preventable death of someone to whom she is indissolubly bonded.
*An abortion analogy: Women who want an abortion generally do not kill their children out of malice. They want to be free from the complications of pregnancy and parenthood. But their desire to be free of those complications is not
in practice detachable from the desire for their children to die.
The same issue crops up in craniotomy, when the child’s skull must be crushed to remove the child from the birth canal. Fortunately craniotomy is seldom necessary these days. Such cases are impermissible on old natural law. (New natural law goes in directions I could not follow.)
The case is different when the uterus is cancerous, and the child dies when the uterus is removed. There is sufficient distance between the will to remove the uterus (for the sake of the life of the mother) and the death of the child as an unintended consequence.
