I. Definitions of Types of Euthanasia
Euthanasia, whether in a medical setting (hospital, clinic, hospice) or
not (at home) is often erroneously described as "mercy killing". Most
forms of euthanasia are, indeed, motivated by (some say: misplaced)
mercy. Not so others. In Greek, "eu" means both "well" and "easy" and
"Thanatos" is death.
Euthanasia is the intentional premature termination of another person's
life either by direct intervention (active euthanasia) or by
withholding life-prolonging measures and resources (passive
euthanasia), either at the express or implied request of that person
(voluntary euthanasia), or in the absence of such approval
(non-voluntary euthanasia). Involuntary euthanasia - where the
individual wishes to go on living - is an euphemism for murder.
To my mind, passive euthanasia is immoral. The abrupt withdrawal of
medical treatment, feeding, and hydration results in a slow and
(potentially) torturous death. It took Terri Schiavo 13 days to die,
when her tubes were withdrawn in the last two weeks of March 2005.
Since it is impossible to conclusively prove that patients in PVS
(Persistent Vegetative State) do not suffer pain, it is morally wrong
to subject them to such potential gratuitous suffering. Even animals
should be treated better. Moreover, passive euthanasia allows us to
evade personal responsibility for the patient's death. In active
euthanasia, the relationship between the act (of administering a lethal
medication, for instance) and its consequences is direct and
unambiguous.
As the philosopher John Finnis notes, to qualify as euthanasia, the
termination of life has to be the main and intended aim of the act or
omission that lead to it. If the loss of life is incidental (a side
effect), the agent is still morally responsible but to describe his
actions and omissions as euthanasia would be misleading. Volntariness
(accepting the foreseen but unintended consequences of one's actions
and omissions) should be distinguished from intention.
Still, this sophistry obscures the main issue:
If the sanctity of life is a supreme and overriding value ("basic
good"), it ought to surely preclude and proscribe all acts and
omissions which may shorten it, even when the shortening of life is a
mere deleterious side effect.
But this is not the case. The sanctity and value of life compete with a
host of other equally potent moral demands. Even the most devout
pro-life ethicist accepts that certain medical decisions - for
instance, to administer strong analgesics - inevitably truncate the
patient's life. Yet, this is considered moral because the resulting
euthanasia is not the main intention of the pain-relieving doctor.
Moreover, the apparent dilemma between the two values (reduce suffering or preserve life) is non-existent.
There are four possible situations. Imagine a patient writhing with insufferable pain.
1. The patient's life is not at risk if she is not medicated with painkillers (she risks dying if she is medicated)
2. The patient's life is not at risk either way, medicated or not
3. The patient's life is at risk either way, medicated or not
4. The patient's life is at risk if she is not medicated with painkillers
In all four cases, the decisions our doctor has to make are ethically
clear cut. He should administer pain-alleviating drugs, except when the
patient risks dying (in 1 above). The (possible) shortening of the
patient's life (which is guesswork, at best) is immaterial.
Conclusions:
It is easy to distinguish euthanasia from all other forms of
termination of life. Voluntary active euthanasia is morally defensible,
at least in principle (see below). Not so other types of euthanasia.
II. Who is or Should Be Subject to Euthanasia? The Problem of Dualism vs. Reductionism
With the exception of radical animal rights activists, most
philosophers and laymen consider people - human beings - to be entitled
to "special treatment", to be in possession of unique rights (and
commensurate obligations), and to be capable of feats unparalleled in
other species.
Thus, opponents of euthanasia universally oppose the killing of
"persons". As the (pro-euthanasia) philosopher John Harris puts it:
" ... concern for their welfare, respect for their wishes, respect for
the intrinsic value of their lives and respect for their interests."
Ronald Dworkin emphasizes the investments - made by nature, the person
involved, and others - which euthanasia wastes. But he also draws
attention to the person's "critical interests" - the interests whose
satisfaction makes life better to live. The manner of one's own death
may be such a critical interest. Hence, one should have the right to
choose how one dies because the "right kind" of death (e.g., painless,
quick, dignified) reflects on one's entire life, affirms and improves
it.
But who is a person? What makes us human? Many things, most of which are irrelevant to our discussion.
Broadly speaking, though, there are two schools of thought:
(i) That we are rendered human by the very event of our conception (egg meets sperm), or, at the latest, our birth; or
(ii) That we are considered human only when we act and think as conscious humans do.
The proponents of the first case (i) claim that merely possessing a
human body (or the potential to come to possess such a body) is enough
to qualify us as "persons". There is no distinction between mind and
abode - thought, feelings, and actions are merely manifestations of one
underlying unity. The fact that some of these manifestations have yet
to materialize (in the case of an embryo) or are mere potentials (in
the case of a comatose patient) does not detract from our essential,
incontrovertible, and indivisible humanity. We may be immature or
damaged persons - but we are persons all the same (and always will be
persons).
Though considered "religious" and "spiritual", this notion is actually
a form of reductionism. The mind, "soul", and "spirit" are mere
expressions of one unity, grounded in our "hardware" - in our bodies.
Those who argue the second case (ii) postulate that it is possible to
have a human body which does not host a person. People in Persistent
Vegetative States, for instance - or fetuses, for that matter - are
human but also non-persons. This is because they do not yet - or are
unable to - exercise their faculties. Personhood is complexity. When
the latter ceases, so does the former. Personhood is acquired and is an
extensive parameter, a total, defining state of being. One is either
awake or asleep, either dead or alive, either in a state of personhood
or not
The latter approach involves fine distinctions between potential,
capacity, and skill. A human body (or fertilized egg) have the
potential to think, write poetry, feel pain, and value life. At the
right phase of somatic development, this potential becomes capacity
and, once it is competently exercised - it is a skill.
Embryos and comatose people may have the potential to do and think -
but, in the absence of capacities and skills, they are not full-fledged
persons. Indeed, in all important respects, they are already dead.
Taken to its logical conclusion, this definition of a person also
excludes newborn infants, the severely retarded, the hopelessly
quadriplegic, and the catatonic. "Who is a person" becomes a matter of
culturally-bound and medically-informed judgment which may be
influenced by both ignorance and fashion and, thus, be arbitrary and
immoral.
Imagine a computer infected by a computer virus which cannot be
quarantined, deleted, or fixed. The virus disables the host and renders
it "dead". Is it still a computer? If someone broke into my house and
stole it, can I file an insurance claim? If a colleague destroys it,
can I sue her for the damages? The answer is yes. A computer is a
computer for as long as it exists physically and a cure is bound to be
found even against the most trenchant virus.
Conclusions:
The definition of personhood must rely on objective, determinate and
determinable criteria. The anti-euthanasia camp relies on bodily
existence as one such criterion. The pro-euthanasia faction has yet to
reciprocate.
III. Euthanasia and Suicide
Self-sacrifice, avoidable martyrdom, engaging in life risking
activities, refusal to prolong one's life through medical treatment,
euthanasia, overdosing, and self-destruction that is the result of
coercion - are all closely related to suicide. They all involve a
deliberately self-inflicted death.
But while suicide is chiefly intended to terminate a life – the other
acts are aimed at perpetuating, strengthening, and defending values or
other people. Many - not only religious people - are appalled by the
choice implied in suicide - of death over life. They feel that it
demeans life and abnegates its meaning.
Life's meaning - the outcome of active selection by the individual - is
either external (such as "God's plan") or internal, the outcome of an
arbitrary frame of reference, such as having a career goal. Our life is
rendered meaningful only by integrating into an eternal thing, process,
design, or being. Suicide makes life trivial because the act is not
natural - not part of the eternal framework, the undying process, the
timeless cycle of birth and death. Suicide is a break with eternity.
Henry Sidgwick said that only conscious (i.e., intelligent) beings can
appreciate values and meanings. So, life is significant to conscious,
intelligent, though finite, beings - because it is a part of some
eternal goal, plan, process, thing, design, or being. Suicide flies in
the face of Sidgwick's dictum. It is a statement by an intelligent and
conscious being about the meaninglessness of life.
If suicide is a statement, than society, in this case, is against the
freedom of expression. In the case of suicide, free speech dissonantly
clashes with the sanctity of a meaningful life. To rid itself of the
anxiety brought on by this conflict, society cast suicide as a depraved
or even criminal act and its perpetrators are much castigated.
The suicide violates not only the social contract but, many will add,
covenants with God or nature. St. Thomas Aquinas wrote in the "Summa
Theologiae" that - since organisms strive to survive - suicide is an
unnatural act. Moreover, it adversely affects the community and
violates the property rights of God, the imputed owner of one's spirit.
Christianity regards the immortal soul as a gift and, in Jewish
writings, it is a deposit. Suicide amounts to the abuse or misuse of
God's possessions, temporarily lodged in a corporeal mansion.
This paternalism was propagated, centuries later, by Sir William
Blackstone, the codifier of British Law. Suicide - being self-murder -
is a grave felony, which the state has a right to prevent and to punish
for. In certain countries this still is the case. In Israel, for
instance, a soldier is considered to be "military property" and an
attempted suicide is severely punished as "the corruption of an army
chattel".
Paternalism, a malignant mutation of benevolence, is about objectifying
people and treating them as possessions. Even fully-informed and
consenting adults are not granted full, unmitigated autonomy, freedom,
and privacy. This tends to breed "victimless crimes". The "culprits" -
gamblers, homosexuals, communists, suicides, drug addicts, alcoholics,
prostitutes – are "protected from themselves" by an intrusive nanny
state.
The possession of a right by a person imposes on others a corresponding
obligation not to act to frustrate its exercise. Suicide is often the
choice of a mentally and legally competent adult. Life is such a basic
and deep set phenomenon that even the incompetents - the mentally
retarded or mentally insane or minors - can fully gauge its
significance and make "informed" decisions, in my view.
The paternalists claim counterfactually that no competent adult "in his
right mind" will ever decide to commit suicide. They cite the cases of
suicides who survived and felt very happy that they have - as a
compelling reason to intervene. But we all make irreversible decisions
for which, sometimes, we are sorry. It gives no one the right to
interfere.
Paternalism is a slippery slope. Should the state be allowed to prevent
the birth of a genetically defective child or forbid his parents to
marry in the first place? Should unhealthy adults be forced to abstain
from smoking, or steer clear from alcohol? Should they be coerced to
exercise?
Suicide is subject to a double moral standard. People are permitted -
nay, encouraged - to sacrifice their life only in certain, socially
sanctioned, ways. To die on the battlefield or in defense of one's
religion is commendable. This hypocrisy reveals how power structures -
the state, institutional religion, political parties, national
movements - aim to monopolize the lives of citizens and adherents to do
with as they see fit. Suicide threatens this monopoly. Hence the taboo.
Does one have a right to take one's life?
The answer is: it depends. Certain cultures and societies encourage
suicide. Both Japanese kamikaze and Jewish martyrs were extolled for
their suicidal actions. Certain professions are knowingly
life-threatening - soldiers, firemen, policemen. Certain industries -
like the manufacture of armaments, cigarettes, and alcohol - boost
overall mortality rates.
In general, suicide is commended when it serves social ends, enhances
the cohesion of the group, upholds its values, multiplies its wealth,
or defends it from external and internal threats. Social structures and
human collectives - empires, countries, firms, bands, institutions -
often commit suicide. This is considered to be a healthy process.
More about suicide, the meaning of life, and related considerations - HERE.
Back to our central dilemma:
Is it morally justified to commit suicide in order to avoid certain,
forthcoming, unavoidable, and unrelenting torture, pain, or coma?
Is it morally justified to ask others to help you to commit suicide (for instance, if you are incapacitated)?
Imagine a society that venerates life-with-dignity by making euthanasia
mandatory (Trollope's Britannula in "The Fixed Period") - would it then
and there be morally justified to refuse to commit suicide or to help
in it?
Conclusions:
Though legal in many countries, suicide is still frowned upon, except when it amounts to socially-sanctioned self-sacrifice.
Assisted suicide is both condemned and illegal in most parts of the
world. This is logically inconsistent but reflects society's fear of a
"slippery slope" which may lead from assisted suicide to murder.
IV. Euthanasia and Murder
Imagine killing someone before we have ascertained her preferences as
to the manner of her death and whether she wants to die at all. This
constitutes murder even if, after the fact, we can prove conclusively
that the victim wanted to die.
Is murder, therefore, merely the act of taking life, regardless of
circumstances - or is it the nature of the interpersonal interaction
that counts? If the latter, the victim's will counts - if the former,
it is irrelevant.
V. Euthanasia, the Value of Life, and the Right to Life
Few philosophers, legislators, and laymen support non-voluntary or
involuntary euthanasia. These types of "mercy" killing are associated
with the most heinous crimes against humanity committed by the Nazi
regime on both its own people and other nations. They are and were also
an integral part of every program of active eugenics.
The arguments against killing someone who hasn't expressed a wish to
die (let alone someone who has expressed a desire to go on living)
revolve around the right to life. People are assumed to value their
life, cherish it, and protect it. Euthanasia - especially the
non-voluntary forms - amounts to depriving someone (as well as their
nearest and dearest) of something they value.
The right to life - at least as far as human beings are concerned - is
a rarely questioned fundamental moral principle. In Western cultures,
it is assumed to be inalienable and indivisible (i.e., monolithic).
Yet, it is neither. Even if we accept the axiomatic - and therefore
arbitrary - source of this right, we are still faced with intractable
dilemmas. All said, the right to life may be nothing more than a
cultural construct, dependent on social mores, historical contexts, and
exegetic systems.
Rights - whether moral or legal - impose obligations or duties on third
parties towards the right-holder. One has a right AGAINST other people
and thus can prescribe to them certain obligatory behaviors and
proscribe certain acts or omissions. Rights and duties are two sides of
the same Janus-like ethical coin.
This duality confuses people. They often erroneously identify rights
with their attendant duties or obligations, with the morally decent, or
even with the morally permissible. One's rights inform other people how
they MUST behave towards one - not how they SHOULD or OUGHT to act
morally. Moral behavior is not dependent on the existence of a right.
Obligations are.
To complicate matters further, many apparently simple and
straightforward rights are amalgams of more basic moral or legal
principles. To treat such rights as unities is to mistreat them.
Take the right to life. It is a compendium of no less than eight
distinct rights: the right to be brought to life, the right to be born,
the right to have one's life maintained, the right not to be killed,
the right to have one's life saved, the right to save one's life
(wrongly reduced to the right to self-defence), the right to terminate
one's life, and the right to have one's life terminated.
None of these rights is self-evident, or unambiguous, or universal, or
immutable, or automatically applicable. It is safe to say, therefore,
that these rights are not primary as hitherto believed - but derivative.
Go HERE to learn more about the Right to Life.
Of the eight strands comprising the right to life, we are concerned with a mere two.
The Right to Have One's Life Maintained
This leads to a more general quandary. To what extent can one use other
people's bodies, their property, their time, their resources and to
deprive them of pleasure, comfort, material possessions, income, or any
other thing - in order to maintain one's life?
Even if it were possible in reality, it is indefensible to maintain
that I have a right to sustain, improve, or prolong my life at
another's expense. I cannot demand - though I can morally expect - even
a trivial and minimal sacrifice from another in order to prolong my
life. I have no right to do so.
Of course, the existence of an implicit, let alone explicit, contract
between myself and another party would change the picture. The right to
demand sacrifices commensurate with the provisions of the contract
would then crystallize and create corresponding duties and obligations.
No embryo has a right to sustain its life, maintain, or prolong it at
its mother's expense. This is true regardless of how insignificant the
sacrifice required of her is.
Yet, by knowingly and intentionally conceiving the embryo, the mother
can be said to have signed a contract with it. The contract causes the
right of the embryo to demand such sacrifices from his mother to
crystallize. It also creates corresponding duties and obligations of
the mother towards her embryo.
We often find ourselves in a situation where we do not have a given
right against other individuals - but we do possess this very same
right against society. Society owes us what no constituent-individual
does.
Thus, we all have a right to sustain our lives, maintain, prolong, or
even improve them at society's expense - no matter how major and
significant the resources required. Public hospitals, state pension
schemes, and police forces may be needed in order to fulfill society's
obligations to prolong, maintain, and improve our lives - but fulfill
them it must.
Still, each one of us can sign a contract with society - implicitly or
explicitly - and abrogate this right. One can volunteer to join the
army. Such an act constitutes a contract in which the individual
assumes the duty or obligation to give up his or her life.
The Right not to be Killed
It is commonly agreed that every person has the right not to be killed
unjustly. Admittedly, what is just and what is unjust is determined by
an ethical calculus or a social contract - both constantly in flux.
Still, even if we assume an Archimedean immutable point of moral
reference - does A's right not to be killed mean that third parties are
to refrain from enforcing the rights of other people against A? What if
the only way to right wrongs committed by A against others - was to
kill A? The moral obligation to right wrongs is about restoring the
rights of the wronged.
If the continued existence of A is predicated on the repeated and
continuous violation of the rights of others - and these other people
object to it - then A must be killed if that is the only way to right
the wrong and re-assert the rights of A's victims.
The Right to have One's Life Saved
There is no such right because there is no moral obligation or duty to
save a life. That people believe otherwise demonstrates the muddle
between the morally commendable, desirable, and decent ("ought",
"should") and the morally obligatory, the result of other people's
rights ("must"). In some countries, the obligation to save a life is
codified in the law of the land. But legal rights and obligations do
not always correspond to moral rights and obligations, or give rise to
them.
VI. Euthanasia and Personal Autonomy
The right to have one's life terminated at will (euthanasia), is
subject to social, ethical, and legal strictures. In some countries -
such as the Netherlands - it is legal (and socially acceptable) to have
one's life terminated with the help of third parties given a sufficient
deterioration in the quality of life and given the imminence of death.
One has to be of sound mind and will one's death knowingly,
intentionally, repeatedly, and forcefully.
Should we have a right to die (given hopeless medical circumstances)?
When our wish to end it all conflicts with society's (admittedly,
paternalistic) judgment of what is right and what is good for us and
for others - what should prevail?
One the one hand, as Patrick Henry put it, "give me liberty or give me
death". A life without personal autonomy and without the freedom to
make unpopular and non-conformist decisions is, arguably, not worth
living at all!
As Dworkin states:
"Making someone die in a way that others approve, but he believes a
horrifying contradiction of his life, is a devastating, odious form of
tyranny".
Still, even the victim's express wishes may prove to be transient and
circumstantial (due to depression, misinformation, or clouded
judgment). Can we regard them as immutable and invariable? Moreover,
what if the circumstances prove everyone - the victim included - wrong?
What if a cure to the victim's disease is found ten minutes after the
euthanasia?
Conclusions:
Personal autonomy is an important value in conflict with other, equally
important values. Hence the debate about euthanasia. The problem is
intractable and insoluble. No moral calculus (itself based implicitly
or explicitly on a hierarchy of values) can tell us which value
overrides another and what are the true basic goods.
VII. Euthanasia and Society
It is commonly accepted that where two equally potent values clash,
society steps in as an arbiter. The right to material welfare (food,
shelter, basic possessions) often conflicts with the right to own
private property and to benefit from it. Society strikes a fine balance
by, on the one hand, taking from the rich and giving to the poor
(through redistributive taxation) and, on the other hand, prohibiting
and punishing theft and looting.
Euthanasia involves a few such finely-balanced values: the sanctity of
life vs. personal autonomy, the welfare of the many vs. the welfare of
the individual, the relief of pain vs. the prolongation and
preservation of life.
Why can't society step in as arbiter in these cases as well?
Moreover, what if a person is rendered incapable of expressing his
preferences with regards to the manner and timing of his death - should
society step in (through the agency of his family or through the courts
or legislature) and make the decision for him?
In a variety of legal situations, parents, court-appointed guardians,
custodians, and conservators act for, on behalf of, and in lieu of
underage children, the physically and mentally challenged and the
disabled. Why not here?
We must distinguish between four situations:
1. The patient foresaw the circumstances and provided an advance
directive (living will), asking explicitly for his life to be
terminated when certain conditions are met.
2. The patient did not provide an advanced directive but expressed his
preference clearly before he was incapacitated. The risk here is that
self-interested family members may lie.
3. The patient did not provide an advance directive and did not express
his preference aloud - but the decision to terminate his life is
commensurate with both his character and with other decisions he made.
4. There is no indication, however indirect, that the patient wishes or
would have wished to die had he been capable of expression but the
patient is no longer a "person" and, therefore, has no interests to
respect, observe, and protect. Moreover, the patient is a burden to
himself, to his nearest and dearest, and to society at large.
Euthanasia is the right, just, and most efficient thing to do.
Conclusions:
Society can (and often does) legalize euthanasia in the first case and,
subject to rigorous fact checking, in the second and third cases. To
prevent economically-motivated murder disguised as euthanasia,
non-voluntary and involuntary euthanasia (as set in the forth case
above) should be banned outright.
VIII. Slippery Slope Arguments
Issues in the Calculus of Rights - The Hierarchy of Rights
The right to life supersedes - in Western moral and legal systems - all
other rights. It overrules the right to one's body, to comfort, to the
avoidance of pain, or to ownership of property. Given such lack of
equivocation, the amount of dilemmas and controversies surrounding the
right to life is, therefore, surprising.
When there is a clash between equally potent rights - for instance, the
conflicting rights to life of two people - we can decide among them
randomly (by flipping a coin, or casting dice). Alternatively, we can
add and subtract rights in a somewhat macabre arithmetic.
Thus, if the continued life of an embryo or a fetus threatens the
mother's life - that is, assuming, controversially, that both of them
have an equal right to life - we can decide to kill the fetus. By
adding to the mother's right to life her right to her own body we
outweigh the fetus' right to life.
The Difference between Killing and Letting Die
Counterintuitively, there is a moral gulf between killing (taking a
life) and letting die (not saving a life). The right not to be killed
is undisputed. There is no right to have one's own life saved. Where
there is a right - and only where there is one - there is an
obligation. Thus, while there is an obligation not to kill - there is
no obligation to save a life.
Anti-euthanasia ethicists fear that allowing one kind of euthanasia -
even under the strictest and explicit conditions - will open the
floodgates. The value of life will be depreciated and made subordinate
to considerations of economic efficacy and personal convenience.
Murders, disguised as acts of euthanasia, will proliferate and none of
us will be safe once we reach old age or become disabled.
Years of legally-sanctioned euthanasia in the Netherlands, parts of
Australia, and a state or two in the United States (living wills have
been accepted and complied with throughout the Western world for a well
over a decade now) tend to fly in the face of such fears. Doctors did
not regard these shifts in public opinion and legislative climate as a
blanket license to kill their charges. Family members proved to be far
less bloodthirsty and avaricious than feared.
Conclusions:
As long as non-voluntary and involuntary types of euthanasia are
treated as felonies, it seems safe to allow patients to exercise their
personal autonomy and grant them the right to die. Legalizing the
institution of "advance directive" will go a long way towards
regulating the field - as would a new code of medical ethics that will
recognize and embrace reality: doctors, patients, and family members
collude in their millions to commit numerous acts and omissions of
euthanasia every day. It is their way of restoring dignity to the
shattered lives and bodies of loved ones.
