Euthanasia

In a previous post, I reflected on some of the ethical considerations involved in abortion. My emphasis was placed on the understanding that an unborn child was entitled to rights alike any other person. What I neglected to discus in any detail was whether it was justifiable for a parent or doctor to assume the right to take life. I would like now to address this question in greater depth in relation to the question of euthanasia. Should individuals have the right to choose death and, if so, is it the role of the physician in assisting an incapacitated patient to this end?

Responsibility of the physician
The principle of non-maleficence (not doing harm) has been a core of medical ethics since the time of Hippocrates – the ‘father of medicine’. Under the Hippocratic Oath the physician swears:
“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel…”[1]
I don’t believe you can remove the ethical foundational of the medical practice without weakening the entire structure, and history proves my point. In my view, this is sufficient reason to exclude physician-assisted suicide.

Right to take life
I think it is proper to be extremely hesitant to grant the power to take life to any person or institution, primarily because such power is so often abused. As Lord Acton famously stated, “All power corrupts; absolute power corrupts absolutely”.

Abortion, euthanasia and capital punishment all carry with them the risk that the power may be abused. It is by no means alarmist to suggest that this is likely to occur if euthanasia were legalized, as this is precisely what has occurred in the past. It was recognized at the Nuremberg trials that the Nazi euthanasia programs were a natural progression from mercy killings by German doctors in the 1920’s. Designating the right to take life detracts from a belief in the dignity and value of all life, creating opportunity for the violation of the human right to life.[2]

Right to choose death
I think the majority of people consider life to be the sole possession an individual. The argument goes: ‘It’s my life, so, assuming I am not compromising the well-being of others, it’s my choice how I use it, and my choice how I end it'. Putting aside the other issues of euthanasia, is suicide ethically defensible?

Personally, I think suicide undermines the dignity of human life and I also do not think that life is the agent’s possession.[3] Certain behavior is not just preferable but obligatory and, as such, freedom is secondary to morality. We have the power to take life, so in law we place restrictions upon ourselves to prevent the abuse of this power. Similarly, we have the power to end our lives and live our lives in a manner that is morally indefensible and here also the law is a tool by which this also should be restricted.[4]

Issue of Suffering
On a more philosophical and abstract note, I think suffering is first and foremost an existential problem and it can not be solved by physicians. I think legalizing euthanasia medicalises the issue, denying psychological, cultural and spiritual factors. Death is not the answer to the issue of suffering.

Conclusions
The Netherlands provides an interesting example of the impact of legalizing euthanasia. Initially, the law specified that the it must be carried out only on the terminally ill and only by consent. The first of these restrictions has now been removed. The second is also somewhat compromised, with almost six thousand reported cases in a single year of non-voluntary euthanasia.[5] Studies also show a complication rate of 23%. So much for that peaceful death.

It is entirely right that individuals maintain the right to refuse treatment, particularly as many drugs have potential side-effects. Physicians’ responsibility to care for their patients does not compel them to force beneficial medication upon them, but it does compel them not to force harmful medication upon them. To allow physicians this power undermines the medical profession and societies ethical foundations.



[1] Hippocratic Oath, 4th century BC
[2] Of course, there are cases where the right to take life is defensible and appropriate as it prevents the loss of life. This applies to abortion when the mother’s life is endangered and also in war.
[3] 1 Corinthians 6:19-20
[4] As clarification, the law is society’s tool, not the individuals. Refer to Robert Bolt’s play, A Man for All Seasons, for an explanation of why the latter can not be the case.
[5] Remmelink Report, 1991

Society and Justice

Should society punish law-breakers on the grounds of retribution, rights, or the welfare of society?

I should, first of all, clarify what I mean by these terms. Retribution presents punishment as a matter of justice. Immanuel Kant argued that, “Judicial punishment can never be used merely as a means to promote some other good for the criminal himself or for civil society, but instead it must in all cases be imposed on him only on the ground that he has committed a crime” (The Metaphysical Elements of Justice). Justice for Kant is the ultimate end. No man* ought to be wrongfully punished, even if it would result in huge social benefits, and no man ought to be justly released from punishment proportional to his crime. To do otherwise would be to compromise justice.

In contrast, an emphasis on rights presumes that the ultimate aim is the liberties of the individual. If we grant that a society owes each individual citizen certain unalienable rights, the foremost being life, liberty and the pursuit of happiness, then it must serve these rights above moral deserts of punishment. Of course, in order to maintain the liberty of citizens a state must also maintain the law and order, necessitating punishment. The ultimate aim is, therefore, the welfare of individuals in society, rather than justice†. Under this conception, there ought to be an emphasis on rehabilitation through punishment. A citizen can be denied their rights only as far as is necessary to protect the right of other citizens, and there is an assumption that these rights will be restored as quickly and fully as possible.

There is also, I think, a third major conception of justice which prioritises society itself over the individuals within that society. Punishment is used to deter actions that might harm society. If an individual has an adversely effects the welfare of society, they ought to be removed from that society. This does not necessarily entail that capital punishment is liberally applied‡, rather incapacitation may serve society better by causing less discontent and unrest.

It sounds irresolute, but I have to say that the best system has to be a combination of the three, but with the emphasis on rights. I don’t want to marginalise justice, and I do think there is a duty to punish culpable offenders, but I don’t see retributive justice as practical. Utopia is not possible in a world of imperfect people and to some extent we need to account for this. And ultimately, I believe, justice will occur regardless of what are courts do.§ The third view I laid out is, quite clearly, the most pragmatic and probably the one most evident in our current system, yet has many short-comings. I think it often leads to inhumane forms of punishment. A felon is still worthy of basic human dignity.

Although I see prison as a necessary form of punishment for the protection of society, I think that prison conditions must be of a certain standard. Apparently, in the US 68% of released prisoners end up back behind bars with three years of their release, and I doubt other nations are any different. Juvenile detention centres and prisons tend to be breed rather than rehabilitate criminals; Bentham’s Panopticon and other highly regimented prison inhibit rehabilitation as released inmates struggle to readjust to life on the outside; and obviously torture (physical and psychological) undermine the dignity of human life. Prison and all other punishments should, of course, be unpleasant in order that they be feared and deter criminal acts, but they must not challenge the recognition of basic human rights.



* Once again, I will apologise to any person offended at the generic use of ‘man’. That is, I regret that you take offence; I don’t regret using the word.
† ‘Justice’ here being in the Kantian sense. Of course, one may see as ‘just’ that which is most beneficial to the greatest number of people, in which case retribution would be ‘unjust’
‡ In fact, the case for capital punishment can be made most strongly with appeals to retributive justice. Kant vehemently supported capital punishment, asserting “If legal justice perishes, then it is no longer worthwhile for men to remain alive on this earth.” I am also quite fond of this extract from his work: “Even if a civil society were to dissolve itself by common agreement of all its members (for example, if the people inhabiting an island decided to separate and disperse themselves around the world), the last murderer remaining in prison must first be executed, so that everyone will duly receive what his actions are worth and so that the bloodguilt thereof will not be fixed on the people because they failed to insist on carrying out the punishment; for if they fail to do so, they may be regarded as accomplices in this public violation of legal justice.” (The Metaphysical Elements of Justice)
§ For those confused, I am talking God’s judgement (not karma).

Abortion

Supporters of abortion campaign for the woman’s right to choose an abortion. I would like to provide a critical response to the legitimacy of this claim, and also look at how it relate to the recent abortion bill approved by the Victorian state government.

Is a foetus a ‘person’?
The crux of the argument rests on how one answers this question. Personally, I would be prone to thinking that life begins at conception, and therefore the foetus is a morally significant person. I take this view because I find no other point at which life can be distinguished. I would argue that late-stage abortion is morally equivalent to infanticide, making it inconsistent to defend one and not the other. Derek Parfit, a British philosopher, has argued that survival is a matter of degrees rather than a matter of all-or-nothing. So one could say a foetus is gradually more and more of a life as it develops, a process that may begin even before conception and would continue without ever reaching a final point. Though I don’t accept this, it seems to be the only real alternative to life from the time of conception.

Rights of the woman
Right to security of the person
Every person, including a pregnant woman, has an inherent dignity that grants them a right to life and security of person. As such, if the process of giving birth would threaten a woman’s life and welfare, then there are, I would think, reasonable grounds for considering an abortion. Although the foetus’ life is of value, I can’t see that we are in any position to prioritise this life over that of the mother. I would argue that in cases where there is a reason to believe the mother’s life would be endangered (beyond normal expectations), the choice of abortion should be made available.

In any case where the actual life and security of the mother are not endangered beyond what may be expected of childbirth, there should be no claim for an abortion. Serious medical, financial or psychological detriment to the mother resulting from raising a child I would consider insufficient grounds for terminating the life of the unborn child. Rather, avenues such as adoption should be considered. I understand that this is terribly difficult for a mother, but I would consider abortion more morally repulsive.

Right over a child
I would argue that parents should have the right to raise their children, and do so in a manner that they perceive as best for the child. However, in an abusive household it is just that the child be removed from the care of their parents for their own protection.* The child’s right to safety, as it were, trumps that of the parent’s right to raise their child in a manner they see fit. So, parents do not have a right over their child in any absolute sense.

Extending this ethic, one would have to agree that any parent who desires and actively pursues the death (or injury) of their child forfeits any right to care that they might have otherwise had. Any mother pursuing an abortion is just the parent who should be denied freedom over the child for which they have so little affection.

Rights of the child
As I made clear before, I consider a foetus a person and, as such, it also has claim to a right to life and security of person. This view is heavily influence by my Christian worldview, which insists both in the dignity of all humans and the moral significance of an unborn child, expressed in biblical passages like Psalm 22:10 and Psalm 139:13.

My previous comments should show how the right to life and security relate to abortion. But I should make clear that these rights necessitate humane manner in which an abortion must be carried out, if one were to occur (as I granted may be defensible in very specific circumstances). There must be minimal pain to both mother and child, and I would also insist on the availability of psychiatric assistance for the mother.

Victorian Abortion Bill
There a number of issues specific to the bill recently passed that I feel are worthy of note:
(1) It makes no restrictions on the means by which abortion is carried out, allowing for inhumane methods.
(2) It allows abortion at any stage of pregnancy. This is particularly significant if we judge ‘personness’ as a continuous concept (Parfit), where a nine-month-old is more morally significant than a one-month-old foetus.
(3) It jeopardises the freedoms of doctors by demanding that they either carry out an abortion or refer patients to a doctor that will.
(4) In my opinion it is wrong that abortion should be seen as purely the choice of the mother, disregarding the other parent. I think that fathers ought to be involved in the process (although this right may excluded if they have no continuing contact with the mother and would be unlikely to be involved in the child’s life if an abortion did not occur).

Although I do not readily support a government system that imposes the moral views of a minority upon a majority, I think the case ought to be made in this case. I am not sure what proportion of the population supports each side, but a (relatively small) majority seems to support legalising abortion. But if the people supported the use of torture would that be sufficient reason for legalising such an atrocity? In my opinion, abortion is excluded in the international laws that affirm human rights (such as the Covenant on Economic, Social and Cultural Rights) recognised by the Australian and, by extension, Victorian governments.


* Practically, of course, it is difficult to enforce this ethic. An outsider will never fully know what goes on in the household. Also, ‘abusive’ is no exclusive category, but a situation may be abusive to lesser or greater degrees. But ultimately, the courts must be responsible for determining the outcome.

Property Rights

With the American election almost upon us, I thought I might take this opportunity to muse over certain issues of political theory from a position of ethics.

Most people recognise care for the poor as valuable and, to some extent, morally obligatory. Yet, these same people will recognise the value and necessity of property rights. But when considering the welfare state it is clear that they two are in opposition, if not mutually exclusive altogether.

John Locke claimed that, “…every man has a ‘property’ in his own ‘person’. This nobody has any right to but himself. The ‘labour’ of his body and the ‘work’ of his hands, we may say, are properly his…That labour put a distinction between them and the common.” (The Second Treatise of Government, 1688).

Locke’s theory of property suggests that the individual has an exclusive right to that which has been earned through their labour (i.e. wages). To deny wages, or steal without consent, it follows, is unethical. This is, of course, very practical as a rule of law because it means that an individual can invest their labour with a guarantee of return, motivating them to work hard and efficiently. The government ought not to take wages from the individual beyond those necessary to fulfil its role of defending property rights.

This conception of property rights can be contrasted with that of utilitarian ethicist, Peter Singer. Singer contends that an individual has a right to the product of his or her labour only so far as it benefits him/her more than it would benefit someone else. Consequentially, it is immoral for an individual not to give up their own property for the advantage of others “at least up to the point at which by giving more one would begin to cause serious suffering for oneself and one’s dependents – perhaps even beyond this to the point of marginal utility” (from his essay ‘Famine, Affluence, and Morality’).

It is counter-intuitive to say that someone else has a right to my wages just by virtue of the fact that they are poorer than me, but still much of what Singer says is genuinely appealing. It affirms the equality of everyone, despite varying ability to earn wages. The ability to make money is, after all, morally insignificant, “since the initial endowments of natural assets and contingencies of their growth and nurture in early life are arbitrary from a moral point of view” (John Rawls, A Theory of Justice). Thus, it is just that there should be equal distribution of wealth.

But can a government practically or morally enforce such an ethic? Certainly not the former and I think not the latter either. I would have to say that the role of the government is to maintain peace and facilitate freedom. A minimalist government can do no more than protect property rights. It then falls on the individual and not the government to give their excess wealth in order to fulfil their moral obligations.

My hope is built

Can we doubt that presently our race will more than realize our boldest imaginations, that it will achieve unity and peace, and that our children will live in a world made more splendid and lovely than any place or garden that we know, going on from strength to strength in an ever-widening circle of achievement? What man has done, the little triumphs of his present state…form but the prelude to the things that man has yet to do.
- H. G. Wells, A Short History of the World (1937)

The cold-blooded massacres of the defenceless, the return of deliberate and organised torture, mental torment, and fear to a world from which such things seemed well nigh banished – has come near to breaking my spirit altogether… “Homo sapiens,” as he has been pleased to call himself, is played out.
- H. G. Wells, A Mind at the End of Its Torture (1946)*

So, I was reading these extracts and it got me thinking about what is man, and what course is he on.† We seem to have some vast potential, but will it ever be fulfilled? I cast my mind back to a particularly profound play:

I think everything on earth is bound to change bit by bit, in fact already is changing before our very eyes. Two or three hundred years, or a thousand years if you like I it doesn’t really matter how long – will bring in a new and happy life. We’ll have no part in it, of course, but it is what we are now living for, working for, yes and suffering for. We’re creating it, and that’s what gives our life its meaning, and its happiness too if you want to put it that way.
- Vershinin (Anton Chekhov, Three Sisters)

It’s quite an attractive theory to see us – homo sapiens, that is – as progressing along some path, predestined for glory. What hope! Such a theory places us as agents of remarkable power and prestige. And it answers all life burning questions – why are we here? why must we endure suffering? is our work, our achievements, our life of any value?

But take heed of Chekhov – the same scene offers another, more sobering view:

When we’re dead, people will fly around in balloons, there will be a new style in men’s jackets and a sixth sense may be discovered and developed, but life itself won’t change, it will still be difficult and full of mystery and happiness as it is now. Even in a thousand years men will still be moaning away about life being a burden. What’s more, they’ll still be as scared of death as they are now. And as keen on avoiding it.
- Tuzenbakh (Anton Chekhov, Three Sisters)

Looking back at all the promising developments of the past – drugs that would free us from disease, machines that would allow us to live lives of leisure, laws that would secure our security and happiness – what has really been achieved? We are richer than ever before, but apparently no happier. We fly, not in balloons but in rockets to outer space, yet no more understand life on our own planet. We know the intricate functions of organism in our ecosystem, are completely at odds with how to manage the environment. Our suicide rate swells with those running from life. But most of us are running from death. I see no development in human nature.

We are apt to exaggerate the abilities of man – but maintaining such faith is a great challenge. Men fail. Macbeth, Lord of the Flies, Animal Farm, Jekyll and Hyde - they all teach us that man is fooling himself with visions of progress and grandeur. Given the opportunity man will forsake any semblance of civilisation in order to fulfil his own insatiable desire for power. We are locked in a cycle from which we cannot save ourselves. Place too much faith in man, Wells' experience suggests, and you will end up with a hopeless, broken spirit.

Trust in the LORD with all your heart
and lean not on your own understanding;
in all your ways acknowledge him,
and he will make your paths straight.
- Proverbs 3:5-6


*okay, so I haven’t actually read any of HG Wells’ acclaimed works; these interesting passages were extracted from Tim Keller’s The Reason for God. highly recommend the book.
† apologies to any women out there who feel excluded by the generic use of ‘mankind’ – i didn’t invent the word, i just use it

By way of introduction and explanation

My name is Nathan, and I am not an alcoholic. However, I do suffer from the tragic condition of overopinionosis. Okay, so it isn’t medically recognised, but the same was once true of depression, boybands and stickittothemanneosis. Don’t put too much faith in the medical profession – they never saved anyone I know of (at least on a permanent basis).

Anyways, I felt inclined to make use of this space as something of an outlet for my opinions. Hopefully something I write will be at least marginally thought-provoking, if not, at least I enjoyed writing it.

I shall write when the moods strikes, and intend to continue said vain practice until such point that I have realised just how mundane and adolescent I have become! But for now…

By the way, for those interested, the title of this blog alludes to a Stephen Crane poem entitled, "Think as I think," said a man.