The Euthanasia Debate: Part 2

Assessing the Options

by J. P. Moreland

In Part One of this series I examined two central aspects of the euthanasia debate. First, several important background concepts in ethical theory were explained. Second, the main features of the libertarian and traditional views of euthanasia were set forth.

The libertarian view, advocated by philosopher James Rachels, states that there is no morally relevant difference between active and passive euthanasia. Moreover, Rachels says, it is biographical life (which includes a person's aspirations, human relationships, and interests), not biological life (being a human being), that is important from a moral point of view (see Part One, p. 13). And if passive euthanasia is morally justifiable in a given case, then so is active euthanasia, since there is no relevant distinction between them.

The traditional view affirms that there is a clear, moral difference between active and passive euthanasia. The former involves the intentional, direct taking of an innocent human's life. The latter involves foregoing treatment (through either withholding or withdrawing treatment) and allowing the natural dying process to run its course. According to the traditional view, active euthanasia is morally forbidden, but passive euthanasia is morally permissible if certain conditions are present: the patient is terminal, death is imminent, treatment is judged extraordinary, and death is not directly intended or caused, but merely foreseen.

At this point we are prepared to assess the options. In what follows, I will (1) critique the libertarian view, (2) defend the traditional view, (3) address the issue of foregoing artificial food and water, and (4) place the euthanasia debate in the larger context of broad, world view issues.

A CRITIQUE OF THE LIBERTARIAN VIEW

Arguments for the View

There are five primary arguments for the libertarian view.[1] The first two are related to the biological/biographical and the active/passive distinctions discussed above.

Argument 1: The Argument from Autonomy. Since biological life (being a human being) is not the real, moral issue, then life is not intrinsically valuable or sacred simply because it is human life. The important thing is that one has biographical life -- and this involves a person's ability to state, formulate, and pursue autonomously chosen interests, desires, and so forth. If a person autonomously chooses to end his or her life or have someone else assist him or her in doing so, then it is morally permissible. One should be free to do as one chooses as long as no harm is done to others.

Argument 2: The Equivalence Argument. There is no morally relevant distinction, the libertarian view says, between active and passive euthanasia. Passive euthanasia is sometimes morally permissible. Thus, active euthanasia is sometimes morally permissible. The Smith and Jones cases, described in Part One of this article, were presented by Rachels as an illustration of his view that active and passive euthanasia are morally equivalent.

Argument 3: The Argument from Mercy. It is cruel and inhumane, it is said, to refuse the plea of a terminally ill person that his or her life be ended to avoid unnecessary suffering and pain. Allowing such a person to terminate his or her life is an act of mercy.

Argument 4: The Best Interests Argument. If an action promotes the best interests of everyone concerned and violates no one's rights, the libertarian view maintains, then that action is morally acceptable. In some cases, active euthanasia promotes the best interests of everyone concerned and violates no one's rights. Therefore, in those cases active euthanasia is morally acceptable.

Argument 5: The Golden Rule Argument. Moral principles, it is argued, ought to be universalizable. In other words, if I don't want someone to apply a rule to me, I shouldn't apply it to others. Similarly, if I want someone to apply a rule to me, I ought to be willing to apply it to others. Now, suppose I were given a choice between two ways to die. First, I could die quietly and without pain, at the age of eighty, from a fatal injection. Or, second, I could choose to die at eighty-plus-a-few-days of an affliction so painful that for those few days before death I would be reduced to howling like a dog, with my family standing helplessly by. The former death involves active euthanasia, and if I would choose it under such circumstances, I should be willing to permit others to choose it too.

Criticisms of the View

Since the first two arguments above are so central to the libertarian viewpoint, they require special treatment. Before we consider these, let us briefly examine arguments three, four, and five.

The Argument from Mercy

Critics of the libertarian view have responded to the argument from mercy in at least four ways. First, there are very few cases where modern medicine cannot alleviate suffering and pain. It is wrong ethical methodology to build an ethical doctrine on a few problem cases. Libertarian advocates violate this principle by placing too much weight on an argument that applies only to a small number of situations.

Second, though this can be abused, value can be found in suffering. One can grow through it; one can teach others how a wise, virtuous person handles life's adversities -- including physical suffering and death; one can show that one cares for his or her membership in community with others and that it is not right to abandon being present to one another in time of need (e.g., a conscious, dying patient can signal his or her commitment to community by not giving up on life; the community in turn can continue to value and care for the dying patient); and one can affirm the fact that people have value and purpose beyond happiness, the absence of pain, or the ability to pursue autonomously chosen goals.[2]

Third, even in cases where death is imminent and pain cannot be minimized or eliminated through normally accepted dosages of medication, active euthanasia is not the only option. A doctor can give the necessary pain medication if the intent is solely to alleviate pain and not to kill, even if it can be foreseen that such an action will hasten death. In this case death is a foreseen, tolerated, but unintended effect.

Finally, critics of the argument from mercy who are theists point out that life is a gift from God and that we are not the sole, absolute owners of our lives. Thus, active euthanasia is an act of rejecting life as a gift from God and it fails to trust the providential care of God and the possibility of good that can result from suffering (see point number two above). The strength of this argument depends on whether one accepts theism and on the version of theism one adopts. For example, views of God which picture Him as removed and uncaring will not be relevant here, but the existence of the biblical God is very relevant to this argument.

The Golden Rule Argument and the Argument from Best Interests

Two responses have been offered that apply equally to the Golden Rule argument and the best interests argument. First, both arguments beg the question against a sanctity of life view in favor of a quality of life view. If (in theological language) life is sacred because humans are made in the image of God, or if (in philosophical language) persons have intrinsic value simply by being human and thus are ends in themselves, then active euthanasia inappropriately treats a person as a means to an end: a painless state of death. Even if we grant that a painless state is a good end, it is immoral to accomplish even a good end by an evil means. Intentionally taking the life of an innocent human being is wrong, regardless of the end it accomplishes. Such an act is dehumanizing because it treats a human being (which has intrinsic value and is an end in itself) as a mere thing (which merely has instrumental value and is a means to an end).

Not everything people take to be in their own best interest is morally acceptable. Similarly, not everything people would wish to have done to them is morally appropriate. Quality of life judgments are often subjective and thus can be morally defective. Put differently, people can dehumanize themselves -- and actually do so in active euthanasia by intentionally killing themselves (or by others intentionally killing them). The strength of this argument hinges on the debate about the relative importance of biological and biographical life (more will be said about that debate below).