Euthanasia 3.4 - 83 Cha pte r 6 ogy with the right to...

Info iconThis preview shows pages 1–8. Sign up to view the full content.

View Full Document Right Arrow Icon
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Background image of page 2
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Background image of page 4
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Background image of page 6
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Background image of page 8
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: 83 Cha pte r 6 ogy with the right to property will make the point dear. If a man owns something, he has the right to it even when its possession does him harm, and we have no right to take it from him. But if one day it should blow away, maybe nothing requires us to get it back for him; we could not deprive him ofit, but we may allow it to go. This is not to deny that it will often be an unfriendly act or one based on an arrogant judgment when we refuse to do what he wants. NevertheleSS, we would be within our rights, and it might be that no moral objection of any kind would lie against our refusal. t is important to emphasize that a man’s rights may Stand between us and the action we would clearly like to take for his sake. They may, of course, also prevent action which we would like to take for the sake of others, as when it might be tempting to kill one man to save several. But it is interesting that the limits of allowable interference, however uncertain, seem stricter in the first case than the senond. Perhaps there are no cases in which it would be all right to kill a man against his will for his cum Satire unless they could equally well be described as cases of allowing him to die, as in the example of turning off the respirator. However, there are cir- cumstances, even if these are very rare, in which one man's life would justifiably be sacrificed to save others, and "killing" would be the only description of what was being done. For instance, a vehicle which had gone out of control might be steered from a path on which it would kill more than one man to a path on which it would kill one.‘3 But it would not be permissible to steer a vehicle towards someone in order to kill him, against his will, for his own good. An analogy with property rights illustrates the point. One may not destroy a man's property against his will on the grounds that he “mid be better off without it; there are, however, circumstances in which it could be destroyed for the sake of others. If his house is liable to fall and kill him, that is his affair; it might, however, with— out injustice be destroyed to stop the spread of a fine. 1% see then that the distinction between active and passive, important as it is elsewhere, has a special importance in the area of euthanasia. It should also be clear why James Rachels’ other argument, that it is often "more humane“ to kill than to allow to die, does not show that the dis- tinction between active and passive euthanasia is morally irrelevant. It might be "more humane" in this sense to deprive a man of the property that brings evils on him, or to refuse to pay what is Owed to Hume’s profligate debauchee; but if we say this we must admit that an act which is “more humane" than its alternative may be morally Objec- tionable because it infringes rights. So far we have said very little about the right to serVice as opposed to the right to noninterfer— once, though it was agreed that both might be brought under the heading of "the right to life." What about the duty to preserve life that may belong to special classes of persons such as bodyguards, firemen, or doctors? Unlike the general public, they are not within their rights if they merely refrain from interfering and do not try to sustain life. The subject’s claim-rights are twofold as far as they are concerned, and passive as well as active euthanasia may be ruled out here if it is against his will, This is not to say that he has the right to any and every service needed to save or prolong his life; the rights of other people set limits to what may he demanded, both because they have the right not to be inter— fered with and because they may have a competing right to services. Furthermore, one must inquire just what the contract or implicit agreement amounts to in each case. Firemen and bodyguards presum— ably have a duty which is simply to preserve life, within the limits of justice to others and of reason~ ableness to themselves. With doctors it may, how— ever, be different, since their duty relates not only to preserving life but also to the relief of suffering. [t is not clear what a doctor’s duties are to his patient if life can be prolonged only at the cost of suffering or suffering relieved only by measures that shorten life. George Fletcher has argued that what the doc— tor is under contract to do depends on what is gen erally done, because this is what a patient will rea~ sonany expect.“1 This seems right. If procedures are part of normal medical practice, then it seems that the patient can demand them however much it may be against his interest to do so, Once again, it is not a matter of what is "most humane.” That the patient’s right to life may set limits to permissible acts of euthanasia seems undeniable. If he does not want to die, no one has the right to practice active euthanasia on him, and passive euthanasia may also be ruled out where he has a right to the services of doctors or others. Perhaps few will deny what has so far been said about the impermissibility of acts of euthan— asia simply because we have so far spoken about the case of one who positively wants to live, and about his rights, whereas those who advocate euthanasia are usually thinking either aimut thoso who wish to die or about those whose wishes can— not be ascertained either because they carmot prop— erly be said to have wishes or because. fort-one rea— son or another, we are unable to form a reliable estimate of what they are. The question that must now be asked is whether the latter type of case, where euthanasia though not involuntary would again be nonvoluntary, is different from the one discussed so far. Would we have the right to kill someone for his own good so long as we had no idea that he positively wished to live? And what about the life—prolonging duties of doctors in the same circumstances? This is a very difficult prob- lem. On the one hand, it seems ridiculous to sup pose that a man‘s right to life is something which generates duties only where he has signaled that he wants to live; as a borrower does indeed have a duty to return something lent on indefinite loan only if the lender indicates that he wants it back. On the other hand, it might be argued that there is something illogical about the idea that a right has been infringed if someone incapable of saying whether he wants it or not is deprived of some- thing that is doing him harm rathEr than good. Yet on the analogy of property we would say that a right has been infringed. Only if someone had ear- lier told us that in such circumstances he would not want to keep the thing could we think that his right had been waived. Perhaps if we could make confident judgments about what anyorme :in such circumstances would wish, or what he would have wished beforehand had he considered the matter, we could agree to consider the right to litie as “dor- mant,” needing to be asserted if the normal duties were to remain. But as things are, we cannot make any such assumption; we simply do not Suttow what most people would want, or would have wanted, us to do unless they tell us. This is oar-tainly the case so far as active measures to end life are con— cerned. Possibly it is different, or will booome dif— ferent, in the matter of being kept alive, so general is the feeling against using sophisticated proce— dures on moribund patients, and so moot: is this dreaded by people who are old or terminally ill. Once again the distinction between active and pas— Euthanasia 239 sive euthanasia has come on the scene, but this time because most people’s attitudes to the two are so different. it is just possible that we might pre~ sume, in the absence of specific evidence, that someone would not wish, beyond a certain point, to be kept alive; it is certainly not possible to assume that he- would wish to be killed. in the last paragraph we have begun to broach the topic of voluntary euthanasia, and this we must nOW discuss. What is to be said about the case in which there is no doubt about someone's wish to die: either he has told us beforehand that he would wish it in circumstances such as he is now in, and has shown no sign of a change of mind, or else he tells us new, being in possession of his faculties and of a steady mind. -We should surely say that the objections previously urged against acts of euthanasia, which it must be remembered were all on the ground of rights, had disappeared. It does not seem that one would infringe someone's right to life in killing him with his permission and in fact at his request. Why should someone not be able to waive his right to life, or rather, as would be more likely to happen, to cancel some of the duties of noninterference that this right entails? (He is more likely to say that he should be killed by this man at this time in this manner, than to say that anyone may kill him at any time and in any way.) Similarly, someone may give permission for the destruction of his property, and request it. The important thing is that he gives a critical permission, and it seems that this is enough to cancel the duty normally associated with the right. If someone gives you per- mission to destroy his property, it can no longer be said that you have no right to do- so, and i do not see why it should not be the case with taking a man’s life. An objection might be made on the ground that only God has the right to take life, but in this paper religious as opposed to moral argu- ments are being left aside. Religion apart, there seems to be no case to be made out for an infringe- ment of rights ifa man who wishes todie is allowed to die Or even killed. But of course it does not fol- low that there is no moral objection to it. Even with property, which is after all a relatively small matter, one might be wrong to destroy what one had the right to destroy. For, apart from its value to other people, it might be valuable to the man who wanted it destmyed, and charity might require us to hold our hand where justice did not. 2-11] Cha p te r 6 Let its review the conclusion of this part of the argument, which has been about euthanasia and the right to life. It has been argued that from this side come stringent restrictions on the acts of euthanasia that could be morally permissible. Active nonvoluntary euthanasia is ruled out by that part of the right to life which creates the duty of non— interference, though passive nonvoluntary eutha— nasia is not ruled out, except where the right to life—preserving action has been created by some special condition such as a contract between a man and his doctor, and it is not always certain just what such a contract involves. Voluntary euthanasia is another matter: as the preceding paragraph sug- gested, no right is infringed if a man is allowed to die or even killed at his own request. Turning now to the other objection that nor- mally holds against inducing the death of another, that it is against charity, or benevolence, we must tell a very different story. Charity is the virtue that gives attachment to the good of others, and because life is normally a good, charity normally demands that it should be saved or prolonged. But as we so defined an act of euthanasia that it seeks a man’s death for his own sake—for his good—charity will normally speak in favor of it. This is not, of course, to say that charity can require an act of euthanasia which justice forbids, but if an act of euthanasia is not contrary to justice—that is, it does not infringe rightsucharity will rather be in its favor than against. Once more the distinction between nonvolun— tary and voluntary euthanasia must be considered. Could it ever be compatible with charity to seek a man's death although he wanted to live, or at least had not let us know that he wanted to die? It has been argued that in such circumstances active euthanasia would infringe his right to life, but pas- sive euthanasia would not do so, unless he had some special right to life—preserving service from the one who allowed him to die, What would char— ity dictate? Obviously when a man wants to live there is a presumption that he will be benefited if his life is prolonged, and if it is so the question of euthanasia does not arise. But it is, on the other hand, possible that he wants to live where it would be better for him to die: perhaps he does not realize the desperate situation he is in, or perhaps he is afraid of dying. So, in spite of a very proper resis tance to refusing to go along with a man’s own wishes in the matter of life and death, someone might justifiably refuse to prolong the life even of someone who asked him to prolong it, as in the case of refusing to give the w0unded soldier a drug that would keep him alive to meet a terrible end. And it is even more obvious that charity does not always dictate that life should be prolonged where a man’s own wishes, hypothetical or actual, are not known. So much for the relation of charity to nonvo- luntary passive euthanasia, which was not, like nonvoluntary active euthanasia, ruled out by the right to life. Let us now ask whatcharity has to say about voluntary euthanasia, both active and pas— sive. It was suggested in the discussion of justice that if of sound mind and steady desire, a than might give others the right to allow him to die or even to kill him, where otherwise this would be ruled out. But it was pointed out that this would not settle the question of whether the act was mor- ally permissible, and it is this that we must now consider. Could not charity speak against what juse tice allowed? Indeed it might do so. For while the fact that a man wants to die suggests that his life is wretched, and while his rejection of life may itself tend to take the good out of the things he might have enjoyed, nevertheless his wish to die might here be opposed for his own sake just as it might be if suicide were in questiOn. Perhaps there is hope that his mental condition will improve. Perhaps he is mistaken in thinking his disease incurable. Per haps he wants to die for the sake of someone else on whom he feels he is a burden, and we are not ready to accept this sacrifice whether for ourselves or others. In such cases, and there will surely be many of them, it could not be for his own sake that we will him or allow him to tho, and therefore euthanasia as defined in this paper would not be in question. But this is not to deny that there could be acts of voluntary euthanasia both passive and active against which neither justice nor charity would speak. We have now considered the morality of euthanasia both voluntary and nonvoluntary, and active and passive. The conclusion has been that nonvoluntary active euthanasia (roughly, killing a man against his will or withOut his consent) is never justified; that is to say, that a man's being killed for his own good never justifies the act unless he him- self has consented to it. A man's rights are in? fringed by such an action, and it is therefore con— . -r___.— _—..-v—~.-——q-I up.“ .. trary to justice. However, all the other combina- tions, nonvoluntary passive euthanasia, voluntary active euthanasia, and voluntary passive eutha- nasia, are sometimes compatible with both justice and charity. But the strong condition carried in the definition of euthanasia adopted in this paper must not be forgotten; an act of euthanasia as here understood is one whose purpose is to benefit the one who dies. In the light of this discussion let us look at our present practices. Are they good or are they bad? And what changes might be made, thinking now not only of the morality of particular acts of euthan- asia but also of the indirect effects of instituting different practices, of the abuses to which they might be subject and of the changes that might come about if euthanasia became a recognized part of the social scene. The first thing to notice is that it is wrong to ask whether we should introduce the practice of euthanasia as if it were not something we already had. In fact we do have it. For instance, it is com— mon, where the medical prognosis is very bad, for doctors to recommend against measures to prolong life, and particularly where a process of degener- ation producing one medical emergency after another has already set in, If these doctors are not certainly within their legal rights, this is something that is apt to come as a surprise to them as to the general public. It is also obvious that euthanasia is often practiced where old pe0ple are concerned. If someone very old and soon to die is attacked by a disease that makes his life wretched, doctors do not always come in with life-prolonging drugs. Per— haps poor patients are more fortunate in this respect than rich patients, being more often left to die in peace; but it is in any case a well—recognized piece of medical practice, which is a form of euthanasia. No doubt the case of infants with mental or physical defects will be suggested as another exam- ple of the practice ofeuthanasia as we already have it, since such infants are sometimes deliberately allowed to die. That they are deliberately allowed to die is certain; children with severe spina bifida malformations are not always operated on even where it is thought that without the operation they willdiQJandeveninthe caseofchildrenwithDown‘s Syndrome who have intestinal obstructions, the relatively simple operation that would make it pos~ sible to feed them is sometimes not- performed.‘5 Euthanasia 241 Whether this is euthanasia in our sense or only as the Nazis understood it is another matter. We must ask the crucial question, "ls it for the sake of the child himself that the doctors and parents choose his death?" in some cases the answer may really be yes, and, what is more important, it may really be true that the kind of life which is a good is not possible or likely for this child, and that there is little but suffering and frustration in store for him,” But this must presuppose that the medical prog— nosis is wretchedly bad, as it may be for some spina bifida children. With children who are born with Down's Syndrome it is, however, quite different. Most of these are able to live on for quite a time in a reasonably contented way, remaining like chil- dren all their lives but capable of affectionate rela- tionships and able to play games and perform sim— ple tasks. The fact is, of course, that the doctors who recommend against lifesaving procedures for handicapped infants are usually thinking not of them but rather of their parents and of other chil— dren in the family or of the “burden on society“ if the children survive. So it is not for their sake but to avoid trouble to others that they are allowed to die. When brought out into the open this seems unacceptable: at least we do not easily accept the principle that adults who need special care should be counted too burdensome to be kept alive. It must in any case be insisted that if children with Down’s Syndrome are deliberately allowed to die this is not a matter of euthanasia except in Hitler's sense. And for our children, since we scruple to gas them, not even the manner of their death is "quiet and easy”; when not treated for an intestinal obstruction a baby simply starves to death. Parhaps some will take this as an argument for allowing active euthanasia, in which case they will be in the company of an 5.5. man stationed in the Warthgenau who sent Eich— mann a memorandum telling him that “Jews in the coming winter could no longer be fed" and sub- mitting for his consideration a proposal as to whether "it would not be the most humane solution to kill those Iews who were incapable of work through some quicker means?” If we say we are unable to look after children with handicaps, we are no more telling the truth than was the 5.5, man who said that the Jews could not be fed, Nevertheless, if it is ever right to allow deformed children to die because life will be a mis— ery to them, or not to take measures to Prolong for 24.2 Cbop’aerfi a little the life of a newborn baby whose life cannot extend beyond a few months of intense medical intervention, there is a genuine problem about active as opposed to passive euthanasia. There are well— knowu cases in which the medical staff has looked on wretchedly while an infant died slowly from starvation and dehydration because they did not feel able to give a lethal injection. According to the principles discussed in the earlier part of this paper they would indeed have had no right to give it, Since an infant cannot ask that it should be done. The only possible solution—supposing that vol— untary active euthanasia were to be legalized— woulcl be to appoint guardians to act on the infant's behalf. In a different climate of opinion this might not be dangerous, but at present, when people so readily assume that the life of a handicapped baby is of no value, one would be loath to support it, Finally, on the subject of handicapped chil— dren, another word should be said about those with severe mental defects. For them too it might some- times be right to say that one would wish for death for their sake. But not even severe mental handicap automatically brings a child within the scope even of a possible act of euthanasia. If the level of con- sciousness is low enough it could not be said that life is a good to them, any more than in the case of those suffering from extreme senility. Neverthe- less, if they do not suffer it will not be an act of euthanasia by which someone 0pm {Or their death. Perhaps charity does not demand that strenuous measures are taken to keep peeple in this state alive, but euthanasia does not come into the matter, any more than it does when someone is, like Karen Ann Quinlan, in a state of permanent coma. Much could be said about this last case. It might even be suggested that in the case of unconsciousness this "life" is not the life In which “the right to life" refers. But that is not our topic here. What we must consider, even if only briefly, is the possibility that. euthanasia, genuine euthana— sia, and not contrary no the requirements of justice or charity, should be legalized over a wider area. Here we are up against the really serious problem of abuse. Many people want, and want very badly, to be rid of their elderiy relatives and even of their ailing husbands or wives. Would any safeguards ever be able to stop them describing as euthanasia what was really for their own benefit? And would it be possible to prevent the occurrence of acts which were genuinely of euthanasia but morally impermissible because infringing the rights of a patient who wished to live? Perhaps the furthest we should go is to . encourage patients to make their own con tracts with a doctor by making it known whether they wish him to prolong their life in case of painful terminal illness or of incapacity. A document such as the Living Will seems eminently sensible, and should surely be allowed to give a doctor following the previously expressed wishes of the patient immu— nity from legal proceedings by relatives.” Legal— izing active euthanasia is, however, another matter. Apart from the special repugnance doctors feel towards the idea of a lethal injection, it may be of the very greatest importance to keep a psycholog- ical barrier up against killing. Moreover, it is active euthanasia which is the most liable to abuse. Hitler would not have been able to kill 275,000 people in his "euthanasia" program if he had had to wait for them to need lifesaving treatment. But there are other objections to active euthanasia, even volun- tary active euthanasia. In the first place, it would be hard to devise procedures that would protect people from being persuaded into giving their con- sent. And secondly, the possibility of active voi- untary euthanasia might change the social scene in ways that would be very bad. As things are, people do, by arid large, expect to be looked after it they are old or ill. This is one of the good things that we have, but we might lose it, and be much worse off without it. It might come to be expected that someone likely to need a lot of looking after should call for the doctor and demand his Own death. Something comparable could be good in an extremely poverty—stricken community where the children genuinely suffered from lack of food; but in rich societies such as ours it would surely be a spiritual disaster. Such possibilities should make us very wary of supporting large measures of euthan— asia, even where moral principle applied to the individual act does not rule it out. Notes I would like to thank Derek Parfit and the editors of Philosophy 51 Public Affairs for their very helpful comments. 1. Leo Alexander, "Medical Science under Dictator- ship," New England Journal of Medicine, 141 July 1949, p. 40. 2. For a discussion of culpable and nonculpable igno- rance see Thomas Aquinas, Summit: Thmlogfca, First Part of the Second Part, Question 6, article 5, and Question 19, articles 5 and 6. 3, Dmitri I-‘anin, Tim Notebooks of Salagdin (London, 1976). PP. 66 —6?. 4, Thomas Nagel, "Death," in lames Rachels, ed., Marni Problems (New York, 1971), p. 362. 5. Panin, Soiagrlin, p. 85. 6. Yet some detail needs to be filled in to explain why we Should not say that a scarecrow is beneficial to the plants it protects. Perhaps what is beneficial must either be a feature of the plant itself, such as protective prickles, or else must work on the plant directly, such as a line of trees which give it shade. David Hume. Treatise, Book II], Part II, Section 1. 8. See, for example, 0. D. Raphael, “Human Rights Old and New,” in D. D. Raphael, ed., Political The- ory and the Rights of Man (London, 196?), and foe-1 Feinberg, "The Nature and Value of Rights." The Journal of Value inquiry 4, no. 4 [Winter 1970): 243—257. Reprinted in Samuel Gorovitz, ed., Maml Problems in Medicine (Englewood Cliffs, New Jer— sey, 19%}. 9. Feiriberg, "Human Rights," Mom! Problems in Media cine, p. 465. 10. See, for example, James Rachels, "Active and Pas- sive Euthanasia,” New England Journal of Medicine 2‘32, no. 2 (91am. 19?5}: 78-80. 11. lbid. 12. It is not, however, that justice and charity conflict. Questions for Analysis ‘13. 14. 15. 16. 1?. 18. Euthanasia 243 A man does not lack charity because he refrains from an act of injustice which would have been for someones good. For a discussion of such questions, see my article “The Problem of Abortion and the Doctrine of Double Effect," Oxford Review, no. 5 (1967); reprinted in Rachels, Mam! Problems, and Gorovitz, Moral Problems in Medicine. George Fletcher, “Legal Aspects of the Decision not to Prolong Life," Journal of tlre American Medical Association 203, no. 1 (1 Jan. 1963); 119—122. Reprinted in Gorovitz. [ have been told this by a pediatrician in a well— known medical center in the United States, It is confirmed by Anthony M. Shaw and Iris A. Shaw, “Dilemma of Informed Consent in Children," The New England journal of Medicine 289, no. I? (25 Oct. 1973): 885-4390. Reprinted in Gorovitz. It must be remembered, however, that many of the social miseries of spina bifida children could be avoided. Professor R. B. Zachary i‘s surely right to insist on this. See, for example, "Ethical and Social Aspects of Spina Bifida,“ The Lancet, 3 Aug. 1968, pp. 274—2176. Reprinted in Gorovitz. Quoted by Hannah Arendt. Eft‘limann in lerusafem (London 1963), p. 90. Details of this document are to be found in I. A. Behnke and Sisseia Bok, eds, The Dilemmas of Euthanasia (New York, 1955), and in A. B. Down— ing, ed., Euthanasia and the Right to Life: The Case for Voluntary Euthanasia (London, 1969). I. What does Foot mean by "right to life,” and how does site use this nation to distinguish between active and passive euthanasia? 2. Under what conditions might a person’s life be regarded as no lunger worth living? 3. Why does Foot believe it is not legitimate for us to decide when someone else's life is no longer worth living? 4. Which forms of euthanasia docs Foot regard as legitimate, and which illegitimate? Cite her reasons. 5. Why does Foot believe we don’t have a duty to kill a person who has decided his or her life is no longer north living? 244 Chapter 6 A Moral Principle about Killing Richard Brandt The preceding writers, either explicitly or implicitly, dealt with the moral principle “It is morally wrou g to kill innocent human beings ." In this essay. philosopher Richard Brandt observes that this principle is really more useful in determining blame than for guiding us in making decisions. Brandt thinks a more appropriate principle can be based on the presumed obligation not to kill any luunan being except in justifiable self-defense—unless we have an even stronger monil obligation to do something that can not be done without killing. In Brandl’s view, that other overriding obligation is not to cause injury to another. Brandt is distinguishing, then, between killing and causing injurl, so that not every act of killing is an act of injury. After citing examples of what he believes are noninjurious killings and Specihiing conditions under which an act is noninjurious, Brandt argues that a person in irreversible coma is “beyond injury." lf such a person has left instructions that his or her life should be ended, then, in Brandt‘s view, we are under a prima facie obligation to do so. in the absence of explicit instructions, we may attempt to determine what the person's wishes likely would be and carry them out. Of course, if a person has left instructions to be maintained under any circumstances, then we have an obligation to respect that preference. Throughout the essay, Brandt uses the term prima facie duty or obligation, which he has borrowed from the English philosopher William David Ross. Prima facie means "at first sight" or "on the surface." Accordingly. a prima facie duty is one that dictates what l should do when other relevant factors aren’t considered. For example, l have a prima facie duty not to lie in every case in which lying is possible. Likewise, I have a prima facie duty to prevent the needless suffering of others. in other words, all things being equal, this is what I ought to try to do. in this essay, Brandt is taking issue with the commonplace view that killing a person is something that is primal facic wrong in itself. ln his view, killing is wrong only if and because it is an injury to someone, or if and because it runs counter to the person's known preference. ln short, Brandt believes that a principle about the prima facie wrongness of killing derives from principles about when we are prima facie obligated not to injure and when we are prima facie obligated to respect a person’s wishes. One of the Ten Commandments states: “Thou shalt not kill." The commandment does not supply an object for the verb, but the traditional Catholic view has been that the proper object of the verb is "inner cent human beings" (except in cases of extreme necessity), where "innocent" is taken to exclude persons convicted of a capital crime or engaged in an unjust assault aimed at killing, such as members of the armed forces of a country prosecuting an unjust war. Thus construed, the prohibition is taken to extend to Suicide and abortion. (There is a qual— ification: that we are not to count cases in which the death is not wanted for itself or intended as a means to a goal that is wanted for itself, provided that in either case the aim of the act is the avoidance of some evil greater than the death of the person.) Can this view that all killing of innocent human beings is morally wrong be defended, and if not, what alternative principle can be? This question is one the ground rules for answering which are far from a matter of agree- ment. 1 should myself be content if a principle were This article first appeared in the book Beneficent Euthanasia, edited by Marvin Kohl, published by Prometheus Books, Buffalo, N.‘r’., 19.75, and is reprinted by permission of the publisher. identified that could be shown to be one that would be included in any moral system that rational and benevolent persoas would support for a society in which they expected to live. Apparently others would not be so content; so in what follows I shall simply aim to make some observations that! hope will identify a principle with which the consciences of intelligent people will be comfortable. I believe the rough principle I will suggest is also one that would belong to the moral system rational and benevolent people would want for their society. Let us begin by reflecting on what it is to kill. The first thing to notice is that hill is a biological term. For example, a weed may be killed by being sprayed with a chem1cal. The verb kill involve-s essentially the broad notion of death—the change from the state of being biologically alive to the slate of being dead. It is beyond my powers to give any general characterization of this transition, and it may be impossible to give one. If there is one, it is one that human beings, flies, and ferns all share: and to kill is in some sense to bring that transition about. The next thing to notice is that at least human beings do not live forever, and hence killing a human being at a given time must be construed as adoanc— ing the date of its death, or as shortening its life. Thus it may be brought about that the termination of the life of a person occurs at the time t instead of at the time t + k. Killing is thus shortening the span of organic life of something. There is a third thing to notice about kill. It is a term of causal agency and has roots in the legal tradition. As such, it involves complications. For instance, suppose I push a boulder down a moun- tainside, aiming ital a person X and it indeed strikes X, and he is dead after impact and not before (and not from a coincidental heart attack); in that case we would say that [ killed X. On the other hand, suppose I tell Y that X is in bed with Y's wife, and Y hurries to the scene, discovers them, and shoots X to death; in that case, although the unfolding of events from my action may be as much a matter of causal law as the path of the boulder, we should not say that [killed X. Fortunately, for the purpose of principles of the morally right, we can sidestep such complications. For suppose I am choosing whether to do A or B [where one or the other of these “acts” may be construed as essentially inac‘ tionifor example, not doing what I know is the one thing that will prevent someones death); then Euthanasia 24:5 it is enough if I know, or have reason to think it highly probable, that were I to do A, a state of the would including the death of some person or per sens would ensue, whereas were I to do B, a state of the world of some specified different sort would ensue. If a moral principle will tell me in this case whether lam to don or B, that is all [need ltcCIuId be that a moral principle would tell me that I am absoluter never to perform any action A, Such that were I to do it the death of some innocent human being would ensue, provided there is some alter- native action I mighl perfOrm. such that were I to do it no such death would ensue. [t is helpful, I think, to reformulale the tradi- tional Catholic view in a way that preserves the spirit and intent of that view {although some phi- losophers would disagree with this assessment) and at the same time avoids some conceptions that are both vague and more appropriate to a principle about when a person is morally blameworthy for doing something than to a principle about what a person ought morally to do. The terminology I use goes back, in philosophical literature, to a phrase introduced by W D. Ross, but the conception is quite familiar. The alternative proposal is that there is a strong prima Jlacie obligation not to kill any human being except in justifiable self-defense; in the sense {of primal facio) that it is morally wrong to kill any human being except in justifiable selfdefense unless there is an even stronger prima facie moral obli- gation to do something that cannot be done with— out killing. (The term innocent can now be omitted, since if a person is not innocent, there may be a stronger moral obligation that can only be dis- charged by killing him; and this change is to the good since it is not obvious that we have no prima tacie obligation to avoid killing people even if they are not innocent.) This formulation has the result that sometimes, to decide what is morally right, we have to compare the stringencies of conflicting moral obligationsuand that is an elusive business; but the other formulation either conceals the same problem by putting it in another place, or else leads to objectionable implications. (Consider one impli— cation of the traditional formulation for a party of spelunkers in a cave by the oceanside. [t is found that a rising tide is bringing water into the cave and all will be drowned unless they escape at once. Unfortunately, the first man to try to squeeze through the exit is fat and gets wedged inextricably 246 Chapter 6 in the opening, with his head inside the cave. Somebody in the party has a stick of dynamite. Either they blast the fat man out, killing him, or all of them, including him, will drown. The traditional formulation leads to the conclusion that all must drown.) Let us then consider the principle: “There is a strong prima facie moral obligation not to kill any human being except in justifiable self-defense." I do not believe we want to accept this principle wiflmut further qualification; indeed, its status seems not to be that of a basic principle at all, but derivative from some more~basic principles. W D. Ross listed what he thought were the main basic prima facie moral obligations; it is noteworthy that he listed a prima facie duty not to cause injury, but he did not include an obligation not to kill. Pre« sumably this was no oversight. He might have tl-Lought that killing a human being is always an injury, so that the additional listing of an obligation not to kill would be redundant; but he might also have thought that killing is sometimes not an injury and. that it is prima facie obligatory not to kill only when, and because, so doing would injure a sen— tient being. What might be a noninjurious killing? If] come upon a cat that has been mangled but not quite killed by several dogs and is writhing in pain, and 1 poll myself together and put it out of its misery, [have killed the cat but surely not injured it. I do not iniure something by relieving its pain, If some- one is being tortured and roasted to death and I know he wishes nothing more than a merciful ter- mination of life, I have not injured him if I shoot him; I have done him a favor. In general, it seems I have not injured a person if I treat him in a way in which he would want me to treat him it he were fully rational, or in a way to which he would be indifferent if he were fully rational. (i do not think that terminating the life of a human fetus in the third month is an injury; I admit this view requires discussion.1) Consider another type of killing that is not an injury. Consider the case of a human being who has beoome unconscious and will not, it is known, regain consciousness. He is in a hospital and is being ioept alive only through expensive support- ive measures. is there a strong prima {acie moral obligation not to withdraw these measures and not to take positive stops to terminate his life? it seems obvious that if he is on the only kidney machine and its use could save the life of another person, who could lead a normal life after temporary use, it would be wrong not to take him off. [5 there an obligation to continue, or not to terminate, if there is no countering obligation? I would think not, with an exception to be mentioned; and this coincides with the fact that he is beyond injury. There is also not an obligation not to preserve his life, say, in order to have his organs available for use when they are needed. There seems, however, to be another morally relevant consideration in such a case—knowledge of the patient's own wishes when he was conscious and in possession of his faculties. Suppose he had feared such an eventuality and prepared a sworn statement requesting his doctor to terminate his life at once in such circumstances. Now, if it is morally obligatory to some degree to carry Out a person‘s Wishes for disposal of his body and possessions after his death, it would seem to be equally morally obligatory to respect his wishes in case he becomes a "vegetable." In the event of the existence of such a document, I would think that if he can no longer be injured we are free to withdraw life—sustaining measures and also to take positive steps to termi— nate life—and are even morally bound, prima facie, to do so. (If, however, the patient had prepared a document directing that his body be preserved alive as long as possible in such circumstances, then there would be a prima facie obligation not to cease life— Sustaining measures and not to terminate. It would seem obvious, however, that such an obligation would fall far short of giving the patient the right to continued use of a kidney machine when its use by another could save that person’s life.) Some per— sons would not hesitate to discontinue life—sustain— ing procedures in such a situation, but would balk at more positive measures. But the hesitation to use more positive procedures, which veterinarians employ frequently with animals, is surely nothing but squeamishness: if a person is in the state described, there can be no injury to him in positive termination more than or less than that in allowing him to wither by withdrawing life—supportive procedures. If I am right in my analysis of this case, we must phrase our basic principle about killing in such a way as to take into account (1) whether the killing would be an injury and (2) the person's own wishes * l and directives. And perhaps, more important, any moral principle about killing must be Md sim— ply as an implicate of more basic principles about these matters. Let us look for corrobmalifinn of this proposal to how we feel about another of Ease, one in which termination would be of positive benefit to the agent. Let us suppose theta patient has a ter~ minal illness and is in severe pain, subject-only to brief remissions, with no prospect-of any enent that could make his life good, eittnerirn the stmrtorlong term. It might seem that here, with the patient in severe pain, at least life-suppozfiwe-measmes should be discontinued, or positive illumination adopted. But I do not think we would mapt this mference, for in this situation the patient, iiet us suppose, has his preferences and is able bo express deem. The patient may have strong religious convictions and prefer to go on living despite tihe pain; ills-o, surely there is a prima facie moral obligation not posi— tively to terminate his life. Eveniif, as seemingly in this case, the situation is one in which it would be rational for the agent, from the point of view of his own welfare, to direct the termination of his life,2 it seems that if he (irrationally? does the opposite, there is a prima Emile moral obligation not to terminate and some prhna fade obligation to sustain it. Evidently a person’s own evqaressed wishes have moral force. (I bellieve, however, that we think a person's expressed wishes have less moral force when we think the wishes are irra- tional.) What is the effect, in this Lease, iftiite patient himself expresses a preference our termination and would, if he were given the means, terminate his own existence? Is there a prima facie obligation to sustain his life——a nd pain—against his will? .‘Surely not. Or is there an obligation not to take positive measures to terminate his life Saran-1ediateliy~ thereby saving the patient much discomfiort? Again, surely not. What possible reason druid be offered to jus— tify the claim that the answer-its affirmative, beyond theological ones about God’s will and our being bound to stay alive at His pleamare? The Lastly argu— ment I can think of is that theme is some consider— ation of public policy, to the effect: that a recognition of such moral permission might lead to abuses or to some other detriment to society in the Long run. Such an argument does seem weak. It might be questioned whether a patients Euthanasia 247 request should be honored, if made at a time when he is in pain, on the grounds that it is not rational. (T he physician may be in a position to see, how- ever, that the patient is quite'right about his pros- pects and that his personal welfare would be max- irnized by termination.) It might also be questioned whether a patient's formal declaration, written ear— lier, requesting termination if he were ever in his present circumstances should be honored, on the grounds that at the earlier time he did not know what it would be like to be in his present situation. It would seem odd, however, if no circumstances are identifiable in which a patient’s request for terr mination is deemed to have moral force, when his request not to terminate is thought morally weighty in the same circumstances even when this request is clearly irrational. I think we may ignore such arguments and hold that, in a situation in which it is rational for a person to choose termination of his life, his expressed wish is morally definitive and removes both the obligation to sustain life and the obligation not to terminate, Indeed, there is a question whether or not in these circumstances a physician has not a moral obligation at least to withdraw lile‘ supporting mea- sures, and perhaps positively to terminate life. At least there seems to be a general moral obligation to render assistance when a person is in need, when it can be given at small cost to oneself, and when it is requested. The obligation is the stronger when one happens to be the only person in a position to receive such a request or to know about the situ— ation. Furthermore, the physician has acquired a special obligation if there has been a longstanding personal relationship with the patient—-—just as a friend or relative has special obligations. But since we are discussing not the possible obligation to ter- minate but the obligation not to terminate, I shall not pursue this issue. The patient's own expression of preference or consent, then, seems to be weighty. But suppose he is unable to express his preference; suppose that his terminal disease not only causes him great pain but has attacked his brain in such a way that he is incapable of thought and of rational speech. May the physician, then, after consultation, take mat— ters into his own hands? We often think we know what is best for another, but we think one person should not make decisions for another. Just as we must respect the decision of a person who has 248 Chapter 6 decided after careful reflection that he wants to commit suicide, so we must not take the liberty of deciding to bring another’s life to a close contrary to his wishes. So what may be done? Must a person suffer simply because he cannot express consent? There is evidenCe that can be gathered about what conclusions a person would draw if he were in a state to draw and express them. The patients friends will have some recollection of things he has said in the past. of his values and general ethical views. Just as we can have good reason to think, for exam- ple, that he would vote Democratic if voting for president in a certain year, so we can have good reason to think he would take a certain stand about the termination of his own life in various circum— stances. We can know of some persons who because of their religious views would want to keep on liv- ing until natural processes bring their lives to a close. About others we can know that they decid- edly would not take this View. We can also know what would be the rational choice for them to make, and our knowledge of this can be evidence about what they would request if they were able. There are, of course, practical complications in the mechanics of a review board of some kind making a determination of this sort, but they are hardly insurmountable. I wish to consider one other type of case, that of a person who, say, has had a stroke and is lead- ing, and for some time can continue to lead, a life that is comfortable but one on a very low level, and who has an tecedently requested that his life be ter— minated if he comes, incurably, into such a situa- tion. May he then be terminated? in this case, unlike the others, there are probably ongoing pleasant experiences, perhaps on the level of some animals, that seem to be a good thing. One can hardly say that injury is being done such a person by keeping him alive; and one might say that some slight injury is being done him by terminating his existence. There is a real problem here. Can the {slight} goodness of these experiences stand against the weight of an earlier firm declaration requesting that life be ter- minated in a situation of hopeless senility? There is no injury in keeping the person alive despite his request, but there seems something indecent about keeping a mind alive after a severe stroke, when we know quite well that, c0uld he have anticipated it, his own action would have been to terminate his life. [ think that the person’s own request should be honored; it should be if a person's expressed preferences have as much moral weight as I think the“. --:hould have. What general conclusions are warranted by the preceding discussion? I shall emphasize two. First, there is a prima facie obligation not to terminate a person’s existence when this would injure him (except in cases of self-defense or of senility of a person whose known wish is to be terminated in such a condition) or if he wishes not to be termi- nated. Second, there is not a prima facie obligation not to terminate when there would be no injury, Or when there would be a positive benefit (release from pain} in so doing, provided the patient has not declared himself otherwise 0r there is evidence that his wishes are to that effect. Obviously there are two things that are decisive for the morality of terminating a person's life: whether so doing would be an injury and whether it conforms to what is known of his preferences. i remarked at the outset that I would be con— tent with some moral principles if it could be made out that rational persons would want those prin~ ciples incorporated in the consciences of a group among whom they were to live. It is obvious why rational persons would want these principles. They would want injury avoided both because they would not wish others to injure them and because, if they are benevolent, they would not wish others injured. Moreover, they would want weight given to a per- son's own known preferences. Rational people do want the decision about the termination of their lives. where that is possible; for they would be uncomfortable if they thought it possible that others would be free to terminate their lives without con- sent. The threat of serious illness is bad enough without that prospect. On the other hand, this discomfort would be removed if they knew that termination would not be undertaken on their behalf without their explicit consent, except af— ter a careful inquiry had been made, both into whether termination would constitute an injury and whether they would request termination un— der the circumstances if they were in a position to do so. [i 1 am right in all this, then it appears that killing a person is not something that is just prima facie wrong in itself,- it is wrong roughly only if and because it is an injury ofsomeone, or ifand because it is contrary to the known preferences of someone. It would seem that a principle about the prima facie wrongness of killing is derivative from principles about when we are prima facie obligated not to injure and when we are prima facie obligated to respect a person’s wishes, at least about what hap- pens to his own body. 1 do not, however, have any suggestions for a general statement of principles of this latter sort. Questions for Analysis Euthanasia 249 Notes See my “The Morality of Abortion“ in The Monist, 56 (1972), pp. 503—26; and, in revised form, in Abortion: Pro and Con, ed. R. 1.. Perkins (General Learning Press, 1975). See my "The Morality and Rationality of Suicide," in James Rachels. ed. Moml Problems (Harper ‘5: Row, 1975); and, in revised form, in E. S. Shneid— man, ed., Sriicidology: Current Developments (Grune 5t Stratton. 1976). 1. Under what conditions, according to Brandt, can one person be said to injure another? 2. Give an example of killing that muses injury, and of killing that doesn't. 3. How do we determine what u comatose person’s wishes are, if the person has left no directions about terminating his or her life? 4. According to Brandt, under what conditions are we prima facie obliged not to terminate a persori’s existence? Under what conditions is there no such prima facie obligation? EJ‘I Explain the significance (with respect to mercy deaths) of Brandt's deriving a principle about the prima facie wrongness of killing frorn principles about when we are prima facie obligated not to info re and when more pri ma facie obligated to respect a person’s wishes. 6. Would you say that Brandt’s analysis is consistent or inconsistent with a Kantian view of the morality of euthanasia? (In order to answer this question, you of course should first try to apply Kent’s ethics to the problem of euthanasia. Under what conditions, if ever; do you think Kant would approve of a mercy death?) CASE PRESENTATION “i Did It Because I Loved My Son" In early May 1989, Rudolfo Linares visited his son Samuel in a Chicago hospital, where the fifteen—month-old boy, partially brain dead, lay connected to a respira- tor. Samuel’s coma had begun nine months earlier, when he’d suffocated after swallowing an uninflated balloon at a birthday party. Along with his wife Tamara, Rodolfo had been pleading with hospital offi- cials to disconnect the respirator, always to no avail. Once, in December, he disconnected it himself, but security officers reconnected it. After that he decided to hire a lawyer to challenge the hospital in court. it} Chapter 6 Apparently Rudolfo was growing impatient with the legal process. On this visit to the hospital. he brought a hand gun, which he used to hold off nurses, doctors, and police officers as he disconnected the respirator and held his son in his arms. Crying all the while, he sat with his son for a full forty minutes, long after hospital instruments showed that he was dead. “I did it because I loved my son,” he said. Prosecutors immediately charged Linares with first degree murder; but fol~ lowing a storm of national publicity, charges were dropped. Questions for Analysis ‘1'. Who should decide whether to “pull the plug” in cases like this one: the parents, the attending physician, a hospital committee, or the courts? 2. in its Cruzan decision, the US. Supreme Court ruled that states can forbid family members to refuse treatment of an incompetent patient without clear evidence that the patient, if competent, would refuse it. Should its ruling apply to Euthanasia Adkins by “suicide machine” that June. Adkins had suffered from Alzheimer’s disease. The machine, which enabled her to give herself a lethal injection, had been provided by its inventor, lack Kevorkian, a Michigan doctor. Though Kevorkian was barred from using the machine again, no charges were filed against him. Questions for Analysis 1. Did Virginia Harper and Janet Adkins have the moral right to take their own lives? Did Bertram Harper and lock Kevorkian have the moral right to help them? 2. Should there be laws against assisted suicide? in their absence, should people who help others kill themselves be tried for murder? 3. Virginia Harper was terminally ill; lanet Adkins was not. is that an important difference in judging the morality of assisting in their suicides? 251 - ‘ 7 when“ who’ M“: samud’ “ever we” Compateni‘ 4. Should lack Kevorlcian’s suicide machine be made available to terminally ill people? Do people who are seriously ill, but not terminally ill, have a right to use this machine? 3. Suppose the patient in this case had been an adult who had never expressed an opinion about refusing or accepting treatment in such circumstances. Would his family have the moral right to refuse treatment for him? 4. If hospital officials refuse to stop treatment, do family members have the moral right to take matters into their own hands, as Rudolfo Linares did? i . I Selections for Further Reading Baird, Robert and Stuart B. Rosenbaum, eds. Euthanasia: the Moral issues. Buffalo, N.Y.: Prometheus, 1989. Behnke, Iohn A. and Sissela Bok. The Dilemmas of Euthanasia. New York: Double— day, Anchor, 1975. Caughjll, R. E., ed. The Dying Patient: A Supportive Approach. Boston: Little, Brown, 1976. Cooper, I. 5. Hard to Leave When the Music’s Playing. New York: Norton, 1977. Grisez, Germain and Joseph Boyle. Life and Death with Liberty and Justice. Notre Dame, Ind: University of Notre Dame Press, 1979. Horan, Dennis J. and David Mall. Death, Dying and Euthanasia. Westport, Conn: Greenwood Press, 1980. EASE PRESENTATION resisted Suicide ; On August 19, 1990, Bertram Harper called the police to report that his wife, a sixty-nine-year—old woman with terminal cancer, had just died in their Michigan motel room. The couple had flown to Michigan after learning that the state, unlike their home state of California, had no law specifically prohibiting assisted suicide. The day after they arrived, Virginia Harper took an overdose of pain killch in her husband’s presence. Bertram Harper, uncertain the dose would be lethal, tied a plastic bag around her head to ensure her death. Harper was arrested soon afterward. On August 25 the County Prosecutor Kluge, Eike-Henner. The Practice of Death. New Haven: Yale University Press, filed two charges against him—murder and conspiracy to commit murder—and i 1975. thirteen days later a district court judge ordered that the seventy-two-yearf—pilfd Kohl, Marvin, ed, Beneficem Euthanasm Buffalo, My: prometheus press, 1975 retired engmeer be brought to ma] on the charges, whlch carry a penalty 0 e KflblepRoss’ Elisabeth on Death and Dying New York: Macmillan, 1969 imprisonment. The penalty for assisting a suicide in California is five years. I What brought the difference in Michigan and California law to the Harpers' . Questions and Answers on Death and Dying. New York: Macmillan, 1974. Maguire, Daniel C. Death by Choice. Garden City, N.Y.: Doubleday, 1974. attention was another assisted suicide, the highly publicized death of Ianet 252 Chapter 6 Russell, 0. Ruth. F recdom to Die: Moral and Legal Aspects of Euthanasia. New York: Human Sciences Press, 1975; Del], 1976. Steinbeck, Bonnie, ed. Killing and Letting Die. Englewood Cliffs, N.}.: Prentice- Hall, 1980. Weir, Robert E Selective Nontmatment of Handicapped Newborns: Moral Dilemmas in Neonatal Medicine. New York: Oxford University Press, 1984. 7 CAPITAL PUNISHMENT Late on the night of October 4, 1983, in Huntsville, Texas, convicted killer]. D. Autry was taken from his death-row cell in the penitentiary and strapped to a wheeled cot. Intravenous tubes were connected to both arms, ready to administer a dose of poison. Outside, a crowd shouted "Kill him, kill him, kill him!" whenever television lights were turned on. In Washington, Supreme Court Justice Byron White waited for a last-minute application for a stay of execution. The application, written on three sheets of a yellow pad, made a new argument related to another case due to be heard by the Court. Shortly after midnight White granted the stay. The intravenous tubes were disconnected, the straps unbuckled. Autry was returned to his cell. Only in March of 1984 was the execution carried out. The US. Supreme Court decision that paved the way for Autry’s execution was Gregg v. Georgia (1976). In an earlier decision, Furman v. Georgia (1972), the court had ruled that capital punishment as then administered was cruel and unusual punishment, and therefore unconstitutional. The issue in that case was standardless discretion—the freedom of a jury (or, in some cases, a judge) to use its own discretion in determining a sentence without explicit legal standards to guide its decision. In their attempts to get around the decision, some states passed laws making the death penalty mandatory for certain crimes, while others enacted legal standards to guide the discretion of the sentencing jury or judge. In Woodson v. North Carolina (1976), the Supreme Court ruled laws of the first type unconstitutional. In Gregg v. Georgia, it upheld laws of the second type for the crime of murder. Since that decision, capital punishment has withstood one other major legal chaHenge—McClesky v. Kemp (1987). In that case, the Supreme Court ruled against Warren McClesky, a black man who had been sentenced to death for killing a white policeman. McClesky argued that the imposition of the death penalty was unconstitutionally affected by racial bias, and in support of his claim he offered 253 ...
View Full Document

This note was uploaded on 05/18/2010 for the course GENERAL ED UGD 2901 taught by Professor 謝建泉、陶國璋 during the Spring '10 term at CUHK.

Page1 / 8

Euthanasia 3.4 - 83 Cha pte r 6 ogy with the right to...

This preview shows document pages 1 - 8. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online