Lecture 11

1. Lecture 11 Applied Ethics (I) Ending One’s Life

2. 1] Introduction 2] Suicide {a} Views on Suicide {b} Hume’s Defence {c} Kant’s Criticism {d} J.S. Mill’s Harm-to-Others {e} Paternalists’ Response to Mill 3] Euthanasia {a} The Situation {b} The Options {c} The Types of Eithanasia {d} The History {e} The First Ethical View {f} Humanists’ Views {g} James Rachel’s Views {h} Thomas Sullivan’s Views {i} James Rachel’s Reprise 4] Conclusion

3. [ 1 ] Introduction • a matter of life and death • a beginning and an ending • life is more treasurable than death; otherwise, no point of ethics • an ethical management of self: whose responsibility? • varied forms of life termination

4. suicide* • euthanasia* • abortion • death penalty • murder • war • … etc. (Is there a “right to die”?)

5. [ 2 ] Suicide Suicide is defined as an intentional and uncoerced self-killing in which the conditions causing death are self-arranged

6. { a } Views on Suicide • Plato opposed suicide since it "frustrates the decree of destiny“; he also argued that "the gods are our guardians, and that we are a possession of theirs. ... Then there may be reason in saying that a man should wait, and not take his own life until God summons him, as he is now summoning me" • Aristotle also opposed suicide since it is "contrary to the rule of life" • Later Greek and Roman philosophers approved of suicide as a means of ending suffering • Stoic Epictetus suggests that, for some of us, there may be limits to what we can endure in this life and, so, when things get too intolerable, we may wish to end our lives. • Christian Augustine: the more high-minded person is the one who faces life's ills, rather than escapes

7. { b } Hume’s Defence • 18the century’s views on suicide • from the standpoint of the traditional duty-based ethics championed by Grotius and Pufendorf • If suicide is immoral, then it must violate some duty to God, self, or others • … but conclude that there is no such duty

8. There is a self-rule established by God in two forces of nature (i.e., physical laws of the natural world, and purposeful action of the animal world) • As a rule, God has given humans the liberty to alter nature for their own happiness • Suicide is an instance of altering the course of nature for our own happiness • There is no good reason this instance should be an exception to the rule • Therefore, suicide does not violate God's plan

9. When we die, we do not harm society, but only cease to do good • Our responsibility to do good is reciprocally related to benefit we receive from society • When I am dead, I can no longer receive the benefits • Therefore, I do not have a duty to do good

10. { c } Kant’s Criticism • Though it does not violate the rights of others, Kant says self-preservation is our highest duty to ourselves and we may treat our body as we please, so long as our actions arise from motives of self-preservation • people are entrusted with their lives, which have a uniquely inherent value. By killing oneself, a person dispenses with his humanity and makes himself into a thing to be treated like a beast • if a person is capable of suicide, then he is capable of any crime. For Kant, "he who does not respect his life even in principle cannot be restrained from the most dreadful vices“ • suicide is wrong because it degrades our inner worth below that of animals

11. { d } J.S. Mill’s Harm-to-Others • suicide as self-regarding behavior • to restrict the liberty of some persons in order to prevent harm to others --- these others can either be specific individuals (= private harm) or can be the society as a whole (= public harm) • for self-regarding behavior, one may think ill, judge it to be at fault, and may even show disapproval and distaste of it • social responses can function as penalties in a natural and spontaneous judgment, but no other additional purposely legal punishment in the form of government intervention

12. { e } Paternalists’ Response to Mill • paternalism justifies government coercion to protect individuals from self-inflicted harm, or in its extreme version, to guide them, whether they like it or not, towards their own good • the “weak” form of paternalism --- the volenti maxim dictates that to a person who freely consents to a thing, no wrong is done, no matter how harmful to him the consequences may be • necessary to decide on voluntariness and reasonableness of risk involved in suicide • nullifies all paternalistic interventions, and at best only allows for temporary intervention

13. the “strong” form of paternalism is unmeditated by the voluntariness standard • the principle of freedom cannot allow that one shouldbe free not to be free • the permanent and irrevocable loss of freedom is such a great evil that no one ought ever to be allowed to choose it, even voluntarily • there is something in every man that is not his to alienate or dispose of, i.e. humanity, whether in our own person or that of another • not allowing for intervention in this situation would render the whole national character cold and hard, and encourage insensitivity generally and eliminate benevolence

14. [ 3 ] Euthanasia(or mercy killing) When a person commits an act of euthanasia he brings about the death of another person because he believes the latter's present existence is so bad that she would be better off dead, or believes that unless he intervenes and ends her life, it will become so bad that she would be better off dead. The motive of the person who commits an act of euthanasia is to benefit the one whose death is brought about.

15. { a } The situation • when a patient in care is terminally ill; • when a patient in care is in intense pain; and • when a patient in care voluntarily chooses to end his life to escape prolonged suffering

16. { b } The options • first, ignore the patient's request and care can continue as usual; • second, discontinue providing life-sustaining treatment to the patient, and thus allow him to die more quickly. (called it passive euthanasia since it brings on death through nonintervention); • third, provide the patient with the means of taking his own life, such as a lethal dose of a drug (called it assisted suicide, since it is the patient himself who administers the drug); or • finally, take active measures to end the patient's life, such as by directly administering a lethal dose of a drug (called it active euthanasia since the action is the direct cause of the patient's death)

17. { c } Types of Euthanasia • voluntary euthanasia refers to mercy killing that takes place with the explicit and voluntary consent of the patient, either verbally or in a written document such as a living will • nonvoluntary euthanasia refers to the mercy killing of a patient who is unconscious, comatose, or otherwise unable to explicitly make his intentions known (it is often family members who make the request, would be done against the wishes of the patient, and would clearly count as murder.

18. { d } The History • 1970s/80s : in The Netherlands, agreement being reached that no physician would be prosecuted for assisting a patient to die as long as certain guidelines were strictly adhered to, and the guidelines were established to permit physicians to practise voluntary euthanasia in instances where a competent patient had made a voluntary and informed decision to die, the patient's suffering was unbearable, there was no way of making that suffering bearable which was acceptable to the patient, and the physician's judgments as to diagnosis and prognosis were confirmed after consultation with another physician. • 1990s : the first legislative approval for voluntary euthanasia was achieved with the passage of a bill in the parliament of Australia's Northern Territory to enable physicians to practise voluntary euthanasia. • in 1997 the Supreme Court of the United States ruled that there is no constitutional right to physician-assisted suicide. However, the Court did not preclude individual States from legislating in favour of physician-assisted suicide.

19. { e } The First Ethical Views • ancient Greek thinkers seem to have favored euthanasia, even though they opposed suicide • but … Hippocrates (460-370 BCE), the ancient Greek physician, who in his famous oath states that "I will not prescribe a deadly drug to please someone, nor give advice that may cause his death” • Christian, Jewish, and Muslim philosophers opposed active euthanasia, although the Christian Church has always accepted passive euthanasia

20. { f } Humanists’ Views • English humanist Thomas More describes in idealistic terms the function of hospitals where hospital workers watch after patients with tender care and do everything in their power to cure ills • British philosopher Francis Bacon (1561-1626) writes that physicians are "not only to restore the health, but to mitigate pain and dolours; and not only when such mitigation may conduce to recovery, but when it may serve to make a fair and easy passage."

21. { g } James Rachels’ Views • "Active and Passive Euthanasia" (1975) • no moral difference between actively killing a patient and passively allowing the patient to die • techniques of passive euthanasia prolong the suffering of the patient, for it takes longer to passively allow the patient to die • it is cruel to adopt the longer procedure • not that actively killing someone is morally worse than passively letting someone die • letting the patient die involves performing an action by not performing other actions (similar to the act of insulting someone by not shaking their hand).

22. { h } Thomas Sullivan’s Views • "Active and Passive Euthanasia: An Impertinent Distinction?" (1977) • no intentional mercy killing (active or passive) is morally permissible • to aim at death (either actively or passively) is always wrong, but it is not wrong to merely foresee death when discontinuing extraordinary procedures • although extraordinary procedures for prolonging life may be discontinued for terminally ill patients, these procedures are ones that are both inconvenient and ineffective for the patient • If death occurs more quickly by discontinuing extraordinary procedures, it is only a byproduct

23. { i } James Rachels’ Reprise • "More Impertinent Distinctions and a Defense of Active Euthanasia" (1978) • intention (to aim at the death of a patient or to foresee his death) is irrelevant to whether the act is right or wrong • If the acts are identical, one cannot be judged right and the other wrong • to determine whether a given procedure is ordinary or extraordinary, we must first determine whether the patient's life should be prolonged

24. active euthanasia is permissible since it promotes the best interests of everyone • the golden rule supports active euthanasia insofar as we would want others to put us out of our misery if we were in a situation of terminal illness • the categorical imperative supports active euthanasia since no one would willfully universalize a rule which condemns people to unbearable pain before death

25. For http://www.near-death.com/experiences/suicide2.html Against http://www.near-death.com/experiences/suicide3.html

26. [ 4 ] Conclusion • Killing in the context of civic responsibility • An agent is required to do each of two (or more) actions; the agent can do each of the actions; but the agent cannot do both (or all) of the actions. The agent thus seems condemned to moral failure; no matter what she does, she will do something wrong (or fail to do something that she ought to do). • When one of the conflicting requirements overrides the other, we do not have a genuine moral dilemma. So in addition to the features mentioned above, in order to have a genuine moral dilemma it must also be true that neither of the conflicting requirements is overridden. • Some will argue that it is not possible to preclude genuine moral dilemmas. Others will argue that even if it were possible, it is not desirable to do so.