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. The first two are
related to the biological/biographical and the active/passive distinctions discussed
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
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.
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
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
Second, it may not be in my own best interests or in the best interests of others
for me to die. If I am willing to allow others to perform active euthanasia on me
(and, by the Golden Rule argument, I'm willing to do so to them), I am mistaken in
my perspective and leaving out morally relevant information.
For example, I may miss the opportunity to learn things through suffering. Even if a
person is not conscious, he or she can contribute to the community an example of
courage in the face of adversity. This could happen in at least two ways. First, a
person could leave an advanced directive prior to reaching a state of
unconsciousness. Such a directive could express the fact that no heroic means
need to be administered if the person becomes terminal and death is imminent, but
that the person wishes to be kept alive if he or she is not terminal as an expression
to the community of the intrinsic value of human existence. Second, the family and
the rest of the community is given a chance to show courage in the face of
adversity by sacrificially caring for someone when nothing can be given back in
return. These lessons are extremely important, given our current narcissistic
culture with its emphasis on personal peace and comfort. Therefore, the chance to
teach these lessons and exemplify these values should be factored into our thinking
about how we should approach the subject of our own deaths. Hence when one
engages in active euthanasia, one abdicates one's privilege and responsibility to live
out one's life in community with others (and, theists would add, with God).
Problems with the Biological/Biographical View of Life
As noted earlier, a central feature of Rachels's argument from autonomy is the
distinction between the biological and biographical views of life. Here I will address
three critical problems with this distinction.
(1) Rachels's understanding of biographical life, far from rendering biological life
morally insignificant, presupposes the importance of biological human life. His
libertarian view describes biographical life as a unity of capacities, interests, and so
forth that a person freely chooses, and that unites the various stages of his or her
life. Now it is precisely these (and other) features of life that philosophers try to
capture in the notion of an essence or natural kind (e.g., humanness). It is
because an entity has an essence and falls within a natural kind that it can possess
a unity of dispositions, capacities, parts, and properties at a given time and can
maintain identity through the various stages of its biographical life. And it is the
natural kind that determines what sorts of activities are appropriate and natural for
Thus, falling under a natural kind -- being a human being in this case -- is a
necessary condition for (1) having a biographical life in the first place, and (2)
having the possibility of a sort of life appropriate for the kind of organism a thing is.
(For example, Smith ought to learn math and ought not to learn to bark because
Smith is a human and not a dog.) Now, the idea of the natural kind "human being"
is not to be understood as a mere biological concept. Rather, it is a metaphysical
concept that grounds both biological functions and moral intuitions.
In sum, if we ask why biographical life is both possible and morally important, the
answer will be that such a life is grounded in the kind of entity -- a human being in
this case -- that typically can have that life. And the natural kind "human being" is
not merely a biological notion, but a metaphysical notion that includes moral
properties. Human beings have both biological and moral properties and thus are
objects of intrinsic value simply as humans.
(2) Rachels's libertarian view seems to collapse into subjectivism. According to him
the importance of a biographical life is that a person has the capacity to set and
achieve goals, plans, and interests that are important from the point of view of the
individual him/herself. But if this is true, then there is no objective moral difference
in the different goals one chooses. One can only be right or wrong about the best
means to accomplish these goals.
To better grasp this, consider Rachels's treatment of the 1973 "Texas burn case"
where a man known as Donald C. was horribly burned but was kept alive for two
years in the hospital against his will, and is still alive today. Rachels believes this
man's desire to die was rational because he had lost his biographical life. Says
Now what could be said in defense of the judgment that this man's desire to
die was rational? I believe focusing on the notion of his life (in the
biographical sense) points us in the right direction. He was, among other
things, a rodeo performer, a pilot, and what used to be called a "ladies'
man." His life was not the life of a scholar or a solitary dreamer. What his
injury had done, from his point of view, was to destroy his ability to lead the
life that made him the distinctive individual that he was. There could be no
more rodeos, no more aeroplanes, no more dancing with the ladies, and a
lot more. Donald's position was that if he could not lead that life, he didn't
want to live.
But surely some rational life plans are more objectively valuable than others. If a
woman has a life plan to be the best prostitute in America, but has an accident that
confines her to a wheelchair such that she is in no pain, can lead a relatively
productive life in various ways, but can no longer pursue her desire to be the best
prostitute, that person could want to commit suicide. Does it make sense to say
that she would be rational to desire to die? Does it make sense to say that her
biographical life is what gave her life value?
Rachels's view would seem to imply an affirmative answer to both of these
questions. Contrary to Rachels, however, it is clear that this woman was
dehumanizing herself. And it is a moral strike against her community that they
allowed her to reach the point of formulating such a biographical life plan in the first
place. The simple fact is that people can dehumanize themselves by choosing
biographical life plans that are morally wrong, and Rachels's view cannot account
for this fact.
Some manners of life are morally appropriate for humans and others are not. The
difference seems to be grounded in the fact that a human being is a creature of
value, and a choice of life plans can be devaluing to the sort of creature one is.
Without objective content which sets limits for what counts as a morally
appropriate approach to living versus approaches that are trivial, immoral, or
dehumanizing, subjectivism would seem to follow. For Rachels, any life plan is
acceptable for me as long as I have freely chosen it and it doesn't harm others. But
a person can be wrong about his or her point of view.
Rachels denies that his view is equivalent to moral subjectivism. He argues that it is
objectively true that something has value for someone if its loss would harm that
person. But this is a mere formal principle. At best, it only gives us a necessary
condition for a moral principle. But moral principles must have enough content to
serve as action guides (principles with enough teeth to tell us what to do and not
do). Action guides need material content, and, in Rachels's view, the material
content one gives it -- that is, what it means to be harmed -- will depend in large
degree on what interests constitute one's biographical life (the case of Donald C.
illustrates this). But since a choice of interests is subjective in Rachels's view, his
denial of subjectivism fails to be convincing.
(3) According to Rachels, the rule not to kill is no longer morally relevant to people
without biographical lives. This is because the point of the rule is to protect people
with biographical lives. It would seem, then, that a person who no longer has such
a life -- who has no point of view -- is no longer included in our duty not to kill. But
if the person has lost the right not to be killed, it would seem that other rights
would be lost as well, since the right to life is basic to other rights. In this case, it
would be morally permissible to experiment on such a person or kill him or her
brutally. Why? Because we are no longer dealing with an object that has the
Rachels could respond that some other factor is relevant that would forbid killing
the patient violently. Perhaps others would see the act; perhaps such an act would
weaken respect for life; or perhaps the act would bring out hostility in the doctor's
character. The difficulty with this response should be obvious. Cases can be set up
where these factors do not obtain: No one knows about the brutal killing of the
patient; the doctor's psychologist has told him to express his aggression toward
objects that remind him of his mother; and so forth. In these cases there would
seem to be no moral difference between a lethal injection or a more brutal means
of killing. The patient -- who has no life and is not an object of moral consideration
-- approaches thing-like status. If Rachels's libertarian views do, in fact, entail this
conclusion, and if this conclusion is as morally unacceptable as it would seem to be,
then Rachels's views must be mistaken.
The Killing/Letting Die Distinction
The "bare difference" argument involving the Smith and Jones cases (see Part
One) was an attempt to show that two different actions -- one killing and one
letting die -- can have the same intentions and results, and thus are both morally
forbidden despite the difference in actions. In fact, the cases are supposed to
show (as presented by Rachels) that the difference between killing and letting die is
irrelevant. But the cases fail to make the point.
First, they have what some philosophers call a masking or sledgehammer effect.
The fact that the taste of two wines cannot be distinguished when both are mixed
with green persimmon juice fails to show that there is no difference between the
wines. The taste of the persimmon juice is so strong that it overshadows the
difference. Similarly, the intentions and motives of Smith and Jones are so
atrocious, and both acts are so clearly unjustified, that it is not surprising that other
factors of their situation (doing something versus refraining from doing
something) are not perceived as the morally determinative factors in the cases.
Second, the main difficulty with the bare difference argument lies in its inadequate
analysis of a human moral act. Thomas Sullivan put his finger on the problem when
he argued that Rachels makes the distinction between the act of killing and the act
of letting die be "a distinction that puts a moral premium on overt behavior --
moving or not moving one's parts -- while totally ignoring the intentions of the
In our discussion of the principle of double effect (see Part One), we saw that
moral acts are not defined merely in terms of the movements of body parts taken
to secure an end. Rather, a moral act is a whole with a motive, intent, and
means-to-an-end as parts of the act. Only the latter involves overt body
movement and it is really the component of intent that defines the essence of a
The importance of intent can be seen as follows. Suppose a mad scientist places a
remote control device in a person's brain that programs the person to hit the first
person he sees after the operation. After the patient wakes up someone comes in
to see him and is hit on the nose. Contrast this with a second person who strikes
someone on the nose because of hatred and jealousy. Both acts involve the same
set of physical occurrences or means-to-ends (moving body parts to strike
someone). But the first person's behavior was causally determined by an implanted
device and he acted out of no intent at all. The second person acted out of a clear
intent to harm. The second act is immoral in a way the first one is not and the
difference lies in the presence or lack of a morally relevant intention.
Rachels's bare-difference cases differ in means-to-ends, but they have the same
intent. Contrary to Rachels, defenders of the active/passive distinction do not
ground the difference on mere physical occurrences or means-to-ends. The acts of
Smith and Jones drowning the two children differ only in physical movements. But,
as we have seen, that is just part of a human act, not the whole. Rachels leaves
out the intent of the two acts in his analysis. A defender of the traditional view
would not allow such an analysis to stand.
Rachels sets up a different case to try to show that two acts can be the same with
different intentions and, thus, intentions are not a part of an act. Jack visits his
sick and lonely grandmother, and his only intention is to cheer her up. Jill also visits
the grandmother and provides an afternoon of cheer. But Jill does it to influence
the grandmother to include Jill in her will. Both of them did the same thing: they
spent an afternoon cheering up the grandmother. Jill should be judged harshly and
Jack praised, not because they did different acts, but because Jack's character is
good and Jill's faulty.
But if the traditional analysis of human action is correct, then Jack and Jill did not
do the same actions. Their actions may be identical at the level of means-to-ends,
but their intents were different. Jack's action was one of loving his grandmother
and cheering her up by being with her. Jill's action was one of securing a place in
the will by being with her.
In view of these factors, it is clear that the libertarian view of active euthanasia,
expressed by perhaps its most articulate exponent, is inadequate. Most
philosophers agree with this assessment and hold to the traditional view of
euthanasia. Some of their reasons will become clearer as I elaborate on this view.
A DEFENSE OF THE TRADITIONAL VIEW
At least five arguments have been offered in support of the traditional view of
euthanasia. Let us now briefly examine all five.
Argument 1: Active euthanasia violates a person's negative right to be protected
from harm (death), while passive euthanasia only violates a person's positive right
to have a benefit (continued treatment). The former usually has a higher degree of
incumbency than the latter, especially when the negative right being violated
involves death itself.
Two responses have been offered to this argument. First, some deny the
distinction between active and passive euthanasia. (We have already looked at this
and found reasons to uphold the distinction.) Second, it has been pointed out that
the difference between positive and negative rights is too small to justify a denial of
the former and an acceptance of the latter. It does seem that judgments about the
relative importance of negative and positive rights can be somewhat subjective, so
-- taken by itself -- argument one is a weak one.
Argument 2: A mistaken diagnosis can be reversed in passive euthanasia (the
person can get well if the disease is not as serious as was thought), but no such
possibility exists in active euthanasia. The basic response to this argument is that
there are a small number of cases where there is a serious possibility of a mistaken
diagnosis, and only in those cases should active euthanasia be forbidden. When the
diagnosis is clear, active euthanasia is permissible. This response seems to shift the
moral debate about euthanasia to other issues. For example, is active euthanasia
ever permissible, mistaken diagnosis or not? Thus, argument two is best
understood as a warning against active euthanasia and a principle that severely
limits its applicability.
Argument 3: Active euthanasia violates the special duty that physicians have to
patients, namely, the preservation of their lives. Rachels counters this by arguing
that if active euthanasia is justified, then the medical profession is built around the
wrong set of duties. So we need to come up with a more adequate definition for
medicine that allows for the practice of active euthanasia. For the sake of
argument, says Rachels, let's call this newly defined practice "smedicine." The only
difference between "smedicine" and "medicine" is that the former allows and the
latter forbids active euthanasia. Rachels's question, then, is this: Why should we
prefer "medicine" over "smedicine"? In his view, we should not.
Two points can be offered by way of rejoinder. First, the medical profession did not
materialize out of thin air. Rather, it represents the accumulated wisdom and virtue
of several generations. Thus, the burden of proof is surely on anyone who would
recommend a change in one of its foundational values. Second, certain values
seem to be necessary as presuppositions before we can make sense out of
medicine itself, and these values run counter to the practice of "smedicine": the
intrinsic value of each human being beyond mere autonomy, the need to be a
caring presence to one another in difficult times, and the need to use suffering and
death as opportunities to teach lessons about life. Thus, smedicine is not a minor
adjustment in medicine, but a radical alternative that should be rejected.
Argument 4: Active euthanasia weakens respect for human life; thus, even if it
could be justified in a particular case, we could not adopt active euthanasia as a
general policy. This is a slippery slope argument that can take two forms. A logical
slippery slope argument says that if a disputed act A cannot be logically
distinguished from an act B in a morally relevant way, and we know that B is
wrong, then A is wrong too. A causal slippery slope argument says that even
though a disputed act A is really different from a forbidden act B, nevertheless, if
we allow A it will contribute to causing people to do B, and so A should not be
allowed. Argument four is a causal slippery slope argument. Its force needs to be
settled by factual, sociological data because it is an empirical question: What
impact on society will a certain practice have?
Argument 5: The intentional killing of an innocent human life is wrong because
human life is sacred. Because human beings are made in the image of God, they
have intrinsic value as ends in themselves by virtue of their membership in the
natural kind "human being." Active euthanasia violates this fundamental principle.
This is the cornerstone of the traditional view. Advocates of the libertarian view,
however, reject this principle and put a premium on biographical life, individual
liberty, private rights, and autonomy.
FOREGOING ARTIFICIAL AIR, NUTRITION, AND HYDRATION
At this point in our discussion, a word needs to be said about the current debate
regarding the moral appropriateness of foregoing artificial air, nutrition (food), and
hydration (water). Because most of the current discussion is centered on food and
water, we will focus on these. But what is said about them could be equally applied
Some believe that food and water should be viewed as any other treatment, and
cases where passive euthanasia would be justified in general -- cases, for example,
in which it would be appropriate to stop renal dialysis -- are cases where foregoing
artificial nutrition and hydration would be justified. On the other hand, there are
those who argue that artificial food and water should not be foregone (except in
very rare cases stated below) in cases like those listed above. Three reasons are
offered for this.
First, ethically speaking, artificial food and water are in a category different from
life-sustaining medical treatments. The latter clearly function to treat some specific
disease or to assist some diseased bodily function. But food and water do not have
as their direct or immediate intention the cure of any pathological condition
whatsoever. They are not therapeutic treatments at all, much less extraordinary
ones. Rather, food and water are means used to meet basic human needs for life
and to provide comfort. Life-sustaining interventions can be foregone on the
grounds that they are extraordinary treatments, but food and water (and air) are
almost never either extraordinary or treatments, so their withdrawal cannot be
justified in this way.
Second, when an extraordinary treatment is foregone, then death may result. But
such a death need not be directly intended as a final end for the person or as an
immediately caused means to some end (e.g., a painless state that death brings).
It is the disease itself that actually causes death directly. However, if food and
water are withdrawn or withheld, then death is intentionally brought about directly
and immediately by that act itself. In such a case, disease does not directly kill; the
act of foregoing treatment directly kills. Thus, a decision to forego artificial food and
water is a decision to commit active euthanasia.
It might be helpful to compare food and water (which are almost never means of
treatment) with air administered by a mechanical respirator (which is a means of
treatment). Artificial food and water are different from, say, a mechanical
respirator. Respirators assist the breathing functions of the body, but artificial
nutrition and hydration replace the natural bodily functions. Thus, when a
respirator is withdrawn, a person usually goes on breathing. If the person does die,
the removal of the respirator does not directly cause death but merely permits an
existing pathology to run its natural course. Furthermore, a respirator can be an
extraordinary artificial means of treatment and its removal can be morally
justified on this grounds: a respirator can be foregone when a patient is terminal
and death is imminent because (1) death is not intended or directly caused, and
(2) it can be an extraordinary artificial treatment.
When food and water are withdrawn, however, this act itself brings about a new
and lethal situation for the person, namely, a starvation or dehydration situation.
The removal of food and water is morally identical to denying a patient air by
placing a plastic bag over his or her head because they both directly and
intentionally bring about death in a very short time and they deny the patient
ordinary, natural resources needed to sustain life. Thus, food, water, and air should
not be foregone when such an act intentionally or directly causes death and when it
denies the patient a natural resource for life.
There is another reason that food and water are morally different from an
extraordinary life-sustaining treatment. If we forego an extraordinary life-sustaining
treatment, we are focusing on the quality of the treatment itself, and our
intention is to spare a person an unduly burdensome means of medical
intervention. On the other hand, if we forego food and water, we are focusing on
the quality of the patient's life itself, not the treatment. We are not considering
ordinary/extraordinary treatments, but valuable/unvaluable lives. In the latter
case, we make a judgment that the life of a person who is in a certain situation is
no longer morally valuable and we violate our duty to respect human life.
Does this mean that there are no cases where it would be morally permissible to
forego food and water? No, it does not. The only ethically justifiable reasons for
such an act in this view would be those that would also justify the removal of air:
(1) if the food and water would not prolong life perceptibly (the person would die in
a short time span whether or not he or she had nutrition or hydration); (2) death
is not intended or directly caused (e.g., nutrition and hydration are judged
extraordinary treatments given to a dying patient); and (3) the means of
administering the food and water to a terminal patient is extraordinary and
excessively burdensome. In this latter case, if the means used to give food and
water is, say, excessively painful or dangerous, then the administration of the
means itself places an undue burden on the terminal patient and can thus be
foregone. These situations are in the minority, but they do arise.
A CHRISTIAN WORLD VIEW OR MINIMALISTIC ETHICS?
A world view is a person's overall philosophy of life. It includes a person's beliefs
about what is real and true, right and wrong, rational and irrational.
While there are exceptions to the rule, many moderns advocate a secular world
view that has these features: First, we live in a pluralistic society and cannot
agree about the good life; that is, about our view of what is important and morally
right, what the purpose of life is, and what types of persons and communities we
should try to become. Thus, the most important function of ethics and law is to
keep us from harming one another. The most important ethical principle is the
principle of autonomy. If a person has certain wishes regarding his or her life, then
those desires should be honored unless they significantly harm another. We have
no moral right to tell others how to live and die.
Second, I do not exist for morality; rather, morality exists for me. The whole point
of morality is to protect my individual rights, preserve my individual happiness, and
maintain a well-ordered society within which I can seek happiness in whatever way
I define happiness (provided, of course, that I do not harm others). The main
purpose of life is happiness, and pain and suffering are to be avoided whenever
possible. My own goals and purposes are what give my life meaning, and when I
cannot pursue those goals and purposes in a way that satisfies me, my life is no
Third, secularists say, my loyalty to my community is a much lower priority than is
my loyalty to myself. Communities exist for the individual, not vice versa. And
when community loyalties require me to sacrifice personal pleasures in a way that
is not in my own self interest, then I have no obligation to the community.
Fourth, the time and manner of my death is basically my own business and others
have little right to intervene when it comes to my decisions in this area. My life is
my own, death is an act that I must undergo alone, and I have the moral right to
end my life in whatever way I rationally and autonomously choose.
In a number of ways, a Christian world view diametrically differs from the
minimalistic, secular one just presented. First, there are true moral principles that
all men and women ought to know, and there are duties that we have to live by
morally even when we don't want to do so. The principle of autonomy is an
important moral principle, but it is not the only or most important one in all
cases. A person can autonomously choose to treat him/herself in a trivial and
dehumanizing way. If a person wants to cease an ordinary life-sustaining treatment
simply because he or she can no longer play the piano or do some activity that
was once his or her primary source of satisfaction, then that person may still be
making a moral mistake. Why? Because the person should never have received his
or her whole meaning in life through engaging in that activity in the first place.
Second, while happiness is important, it is not the point of life. The main point of
life is to glorify, enjoy, and serve the living God, and a primary feature of a life well
lived is morality. Morality does not merely exist to make me happy. Rather, part of
the very meaning of life is that I should seek to become a virtuous person who
models a morally sensitive life.
Furthermore, while we should not glorify pain and suffering, they can have
meaning. I can grow through them and I can teach others to value life, as well as
give them hope by my example of appropriately coping with pain and suffering and
not giving up on life. Thus, when I am trying to decide what to do with a painful
situation, my consideration should not only be trying to avoid the pain. I should
also try to consider the opportunity pain gives me to grow, teach others, trust
God, and model a concern for a virtuous, moral life.
Third, while I am certainly an individual with rights, I am equally a member of my
community, and I have duties and responsibilities to that community. I must make
my individual moral decisions in light of how they will affect those around me.
Finally, life is not my own to do with as I please. Rather, my life is a gift from God,
and I should face my own death as I believe He would have me face it. This may be
difficult to determine in some cases, but I should at least raise these considerations
when deliberating about when and how I wish to die.
There is one final point that should be made. The modern secular world view has
abandoned the doctrine of the image of God in man. Thus, it does not have the
resources to ground the dignity of a human being. Indeed, many secularists claim
that the belief that someone is special just because he or she is human is
speciesism -- an unjustified bias toward one's own species. In place of the
image of God in man, the "value" of life is justified by the possession of one or
more of a number of criteria: biographical life, rationality, the ability to use
language, possession of a self concept, and so forth. These become criteria either
for personhood or for a meaningful quality of life.
But these surrogates for the image of God in man fail because they are possessed
by different humans in different degrees, and some higher primates can have them
to a greater degree than, say, a defective newborn or elderly human. Thus, these
secular substitutes have difficulty (1) justifying the view that all humans have equal
rights and dignity; (2) justifying the view that humans have more value than
animals; and (3) avoiding the conclusion that advanced creatures on another
planet or humans developed by genetic engineering have more value than current
humans, and thus, anything we wish to do to develop better humans (e.g.,
experimenting on present humans) is prima facie justified.
In a very real sense, the euthanasia debate is yet another crucial battle in an
ongoing cultural war of world views. As the debate accelerates in coming years, it
is critical that Christians be involved, for the stakes are truly high. Indeed, it is
literally a matter of life and death -- for countless individuals and perhaps for our
society as well.
1 Some of these are listed in James Rachels, The End of Life (Oxford: Oxford
University Press, 1986), 151-67. See also, Sidney H. Wanzer, et. al., "The
Physicians Responsibility toward Hopelessly Ill Patients: A Second Look," The New
England Journal of Medicine 320 (30 March 1989):844-49.
2 Cf. Benedict M. Ashley and Kevin D. O'Rourke, Health Care Ethics (St. Louis,
MO: The Catholic Health Association of the United States, 1982), 199-205;
Stanley Hauerwas, Suffering Presence (South Bend, IN: University of Notre
Dame Press, 1986).
3 Rachels, 46-47.
4 Ibid., 54.
5 T. D. Sullivan, "Active and Passive Euthanasia: An Important Distinction,"
reprinted in Biomedical Ethics, eds. Thomas A. Mappes and Jane S. Zembaty
(New York: McGraw-Hill, 1986), 390.
6 Rachels, 93-94.
7 Cf. J. P. Moreland, "Review of The End of Life," The Thomist 53 (October
8 A fuller treatment of this debate can be found in Joanne Lynn, ed., By No
Extraordinary Means (Bloomington, IN: Indiana University Press, 1986).
9 Cf. Daniel Callahan, "Minimalistic Ethics," Hastings Center Report 11 (October
1981):19-25; Hauerwas; Tim Smick, Jim Duncan, J. P. Moreland, Jeff Watson,
Eldercare for the Christian Family (Dallas: Word Publishing, 1990).
10 Cf. Helga Kuhse and Peter Singer, Should the Baby Live? (Oxford: Oxford
University Press, 1985), chapter 6; J. P. Moreland and Norman L. Geisler, The Life
and Death Debate (Westport, CT: Praeger Books, 1990), chapter 3.
11 For more on the relationship between God, morality, and world view, see J. P.
Moreland, Scaling the Secular City (Grand Rapids: Baker Book House, 1987),
chapter 4; J. P. Moreland and Kai Nielsen, Does God Exist? The Great Debate
(Nashville: Thomas Nelson Publishers, 1990), part two.
Part Two in a Two-Part Series on Euthanasia, from the Christian Research Journal, Spring 1992,
page 14. Copyright © 1994 by the Christian Research Institute, P.O. Box 7000, Rancho Santa
Margarita, CA 92688-7000. The Editor-in-Chief of the Christian Research Journal is Elliot Miller.
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