PHIL 2030: Introduction to Ethics
Dr. Robert Lane
Lecture Notes: Tuesday March 25, 2014

 

[6.2.] Utilitarianism and Euthanasia.

 

The term “euthanasia” refers to the practice of allowing someone to die, or helping to bring about that person’s death, in order to end his or her suffering.

 

The word comes from the Greek “eu” (meaning “good”) and “thanos” (meaning “death”).

 

 

[6.2.1.] Euthanasia vs. Physician-Assisted Dying and Suicide.

 

You should keep the following concepts distinct:

 

·         passive euthanasia occurs when someone is allowed to die “naturally” by the removal of life-support, such as the removal of a respirator or feeding-tube. [This is how Terri Schiavo died.[1]]

 

·         active euthanasia occurs when someone actively intervenes in order to cause the death of the patient, such as when a doctor injects the patient with drugs that bring about his or her death.

·         This is how Sigmund Freud died, as described at EMP p.99. It is also the practice for which Dr. Jack Kevorkian was found guilty of second-degree murder.[2]

·         It is currently legal in only three countries: the Netherlands, Luxembourg, and Belgium.

 

·         physician-assisted dying occurs when the patient himself or herself has been diagnosed with a fatal disease and is already dying and brings about his or her own death by taking a lethal dose of drugs received via a doctor’s prescription.

 

·         physician-assisted suicide is the same as physician-assisted dying, except that the patient is not terminally ill, although he or she may have some devastating disease, such as Alzheimer’s disease, or Amyotrophic Lateral Sclerosis (ALS).

 

 

[6.2.2.] Legalized Physician-Assisted Dying.

 

Currently, physician-assisted dying is legal in four American states: Oregon, Washington, Vermont (as of May 2013)[3] and Montana. [It is also legal in the Netherlands, Luxembourg, Belgium, and Switzerland.]

 

Oregon

·         The Death with Dignity Act was passed in Oregon in 1994. Because of court challenges, it was not implemented until 1997.

·         The law requires that two physicians diagnose a patient as terminally ill and judge that the patient is of sound mind. Since the patient must be terminally ill to be eligible for this, it is only physician-assisted dying (and not physician-assisted suicide) that is legal in Oregon.

·         The patient must wait 15 days after requesting the drugs before receiving them.

·         The patient must administer the drugs himself or herself.

·         In Oregon, the drugs most frequently prescribed by physicians under the state’s Death with Dignity Act are the barbiturates Secobarbital and Pentobarbital.[4]

·         Since the Act was passed, many people, most of them cancer patients, have requested and received the assistance of a physician in bringing about their deaths. As of January 22, 2014, 752 people have died in that manner; 63 died with the drugs in 2013.[5]

 

Next we will consider James Rachels’ argument in support of active euthanasia.

 

 

[6.2.3.] In Support of Active Euthanasia: James Rachels.

 

Rachels says that the strongest pro-euthanasia argument is the Argument from Mercy. He considers two versions of this argument:

 

1.      the Utilitarian version

2.      the Utility & Rights version

 

He identifies some serious problems with the first (Utilitarian version) and changes it to the second (Utility & Rights) version in order to avoid those problems.

 

(As covered in EMP ch.7, one of the readings I assigned for last week, utilitarianism also has specific consequences for the issues of marijuana use and our treatment of non-human animals.)

 

 

[6.2.3.1.] The Utilitarian Version of the Argument from Mercy.

 

Here is the first, problematic version of the Argument from Mercy:

 

1.      Any action or social policy is morally right if it serves to increase the amount of happiness in the world or to decrease the amount of misery. Conversely, an action or social policy is morally wrong if it serves to decrease happiness or to increase misery. [This is a simple statement of classical utilitarianism.]

2.      The policy of killing, at their own request, hopelessly ill patients who are suffering pain [i.e., active euthanasia] would decrease the amount of misery in the world [such as in Rachels’ story about Jack, the cancer patient].

3.      Therefore, such a policy would be morally right. (RTD 314)


As Rachels points out, many contemporary philosophers think that there is a problem with classical utilitarianism: it implies that happiness and the avoidance of misery are the only, or at least the most important, moral values. But there are other things that are also morally important:

·         freedom;

·         justice; and

·         respect for individual rights.

 

To illustrate this point, Rachels focuses on freedom of religion:

 

… people might be happier if there were no freedom of religion, for if everyone adhered to the same religious belief, there would be greater harmony among people. There would be no unhappiness caused within families by Jewish girls marrying Catholic boys, and so forth. Moreover, if people were brainwashed well enough, no one would mind not having freedom of choice. Thus happiness would be increased. But, the argument continues, even if happiness could be increased this way, it would not be right to deny people freedom of religion, because people have a right to make their own choices. Therefore, the first premise of the utilitarian argument is unacceptable. (RTD 315)

 

He then considers an even more extreme example, one that is more relevant to euthanasia: the right to life:

 

Suppose a person is leading a miserable life—full of more unhappiness than happiness—but does not want to die. This person thinks that a miserable life is better than none at all. Now I assume that we would all agree that the person should not be killed; that would be plain, unjustifiable murder. Yet it would decrease the amount of misery in the world if we killed this person—it would lead to an increase in the balance of happiness over unhappiness—and so it is hard to see how, on strictly utilitarian grounds, it could be wrong. (RTD 315)

 

So, we value things other than happiness, including personal freedom and autonomy:

 

autonomy (df.): a person’s capacity to make decisions for himself; the ability to guide one’s own life. [from Greek auto, self, and nomos, law]

 

So happiness, it seems, cannot be the only standard of morality.

 

 

[6.2.3.2.] The Utility & Rights Version of the Argument from Mercy.

 

But obviously, happiness is morally important. We don’t have to abandon utilitarianism entirely. As Rachels says, “when an action or a social policy would decrease misery, that is a very strong reason in its favor.” (RTD 315)

 

With this in mind, Rachels proposes a second, stronger version of the Argument from Mercy.

 

1.      If an action promotes the best interests of everyone concerned [modern utilitarianism] and violates no one’s rights, then that action is morally acceptable.

2.      In at least some cases, active euthanasia promotes the best interests of everyone concerned and violates no one’s rights.

3.      Therefore, in at least some cases, active euthanasia is morally acceptable. (RTD 316)

 

This version differs in two important ways from the first version:

·         it refers, not just to happiness and misery, but to peoples’ best interests [in essence, he is shifting from classical to modern utilitarianism]

·         it incorporates a concern for individual rights

 

Discussion: is this argument valid? [yes] Is it sound? [it is up to you to form your own opinion about whether the premises are true…]

 

Rachels’ defense of active euthanasia does not end here. He also argues that passive and active euthanasia are morally equivalent…

 

 

[6.2.3.3.] Active and Passive: Morally Equivalent?

 

In another article, Rachels famously argued that active euthanasia is morally equivalent to passive euthanasia. In other words, he argued that if active euthanasia is immoral, then so is passive euthanasia; and if passive euthanasia is morally permissible, then so is active euthanasia. 

 

On Rachels’ view, there is no moral difference between killing someone and accidentally letting him die when you could easily save him, e.g. no moral difference between deliberately causing someone to drown (e.g., by holding his head under the water) and neglecting to save someone from drowning when you could easily save his life:

 

                … Smith stands to gain a large inheritance if anything should happen to his six-year-old cousin. One evening while the child is taking his bath, Smith sneaks into the bathroom and drowns the child, and then arranges things so that it will look like an accident.

… Jones also stands to gain if anything should happen to his six-year-old cousin. Like Smith, Jones sneaks in planning to drown the child in his bath. However, just as he enters the bathroom, Jones sees the child slip and hit his head, and fall face down in the water. Jones is delighted; he stands by, ready to push the child’s head back under if it is necessary, but it is not necessary. With only a little thrashing about, the child drowns all by himself, “accidentally,” as Jones watches and does nothing.[6]

 

Rachels maintains that the action of Smith and the inaction of Jones are equally bad—Smith is no worse than Jones—both are horrible to the same degree.

 

The question posed by this story is: How can we explain why Smith and Jones are equally bad, when Smith actively brought about the boy’s death and Jones did nothing but and watch the boy die?

 

According to Rachels, rather than focusing on whether a death is caused or allowed in determining whether a case of euthanasia is morally permissible, we should focus on motives and consequences.

 

In general, if the motives are the same, and the consequences are the same, then the actions (or failures to act) are morally equivalent.

 

In the Smith and Jones thought experiment, the two men’s motives are the same (they both want the boy to die so that they will inherit a lot of money), and the consequences are the same (the boy dies in each case). This explains why Smith and Jones are both equally bad, even though only one of them (Smith) actively brings about the death of his cousin.

 

Rachels applies the same reasoning to the case of euthanasia. If the motives are the same (what is desired is that the patient’s suffering end), and the consequences are the same (the patient dies), then there is no moral difference between active and passive. The fact that in active euthanasia, someone actively intervenes so as to bring about the death of the patient, makes no moral difference. It is morally the same as passive euthanasia.

 

In effect, Rachels is rejecting…

 

The Doctrine of Doing and Allowing: (df.) “It is always morally worse to do harm than to allow that same harm to occur.”[7]

 

 

Stopping point for Tuesday March 25. For next time:

                Read all of RTD ch.17: “The Singer Solution to World Poverty” by Peter Singer.

                Study today’s online lecture notes.

                There may be a pop quiz over either or both of those sources of information at the beginning of class.

 

 



[1] For a timeline of the Terri Schiavo case, see http://www.miami.edu/index.php/ethics/projects/schiavo/schiavo_timeline/ , accessed February 21, 2012.

 

[2] Kevorkian died in June 2011. An obituary is here: http://topics.nytimes.com/topics/reference/timestopics/people/k/jack_kevorkian/index.html , accessed October 3, 2011.

 

[3] “Vermont Legalizes Assisted Suicide,” May 21, 2013, URL = <http://rt.com/usa/vermont-assisted-suicide-legalize-591/>, retrieved October 17, 2013.

 

[4] “Annual Report” on Oregon’s Death with Dignity Act, State of Oregon Department of Human Services, URL = < http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year10.pdf >, retrieved October 2, 2011.

 

[5] The U. S. Dept. of Justice sued the state of Oregon, claiming that Oregon’s law violates federal laws governing the use of controlled substances. In particular, the federal government claimed that the practice of physician-assisted dying violates federal drug control laws, because giving narcotics to terminally ill patients with the intention that they will use the drugs to kill themselves is not a legitimate medical use of those drugs. The Supreme Court heard arguments in this case in 2005 and issued a ruling on January 17, 2006. They ruled in favor of the state of Oregon, finding that the federal government did not have the right to decide whether a physician prescribing a fatal dose of narcotics to a terminally ill patient constituted a legitimate medical use of those drugs. The court ruled 6-3 against the Justice Department, with Scalia, Thomas and Roberts dissenting.

 

 

[6] James Rachels, “Active and Passive Euthanasia,” New England Journal of Medicine 292, no.2 (1975), pp.78-80.

 

[7] Russ Shafer-Landau, The Fundamentals of Ethics, Oxford University Press, 2010, p.215. For more information on this doctrine, see Frances Howard-Snyder, “Doing vs. Allowing Harm,” The Stanford Encyclopedia of Philosophy (Fall 2008 Edition), Edward N. Zalta (ed.), URL = < http://plato.stanford.edu/archives/fall2008/entries/doing-allowing/ >.

 




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