communication

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dcolc* $ k t ild(o #Rs$hmro ‘lta ktlhltcRlcdlor ta c t cRm ‘ml!at. mdsk!a ts kd(mRr ldm talo cR!krmdt% -s’m”mR* ,cxamho $mhlm”mo ta c t c (liimR.

mdt “mRolsd xcd okxxmm(% /d talo sdm* ,cxamho xhclro ta c t cd. cxtlsd ta c t #Rsr stmo tam $mot ldtmRmoto s i chh xsdxmRdm(* cd ( ta c t “lshctmo ds Rl!ato* lo rsRchh. cxxm#tc$hm% 0ldxm* am xhclro* cxtl”m mktacdcolc osrmtlrmo octloilmo talo (moxRl#tlsd* lt lo osrmtlrmo rsRchh. cxxm#tc$hm% The single m ost powerful argument in support o f euthanasia is the argument from mercy. It is also an exceptionally simple argument, at least in its m ain idea, w hich makes one uncomplicated point.

Terminally ill patients som etim es suffer pain so horrible that it is beyond the com prehension o f those w h o have not actually experienced it. Their From “Euthanasia.” in Tom Beauchamp, ed.. Matters o f Life and Death, Second Edition (1986), pp. 49-52 (McGraw-Hill Publishers).TTgsuM TaohJtem a l Rceuhyhrth 229 suffering can be so terrible that we do not like even to read about it or think about it; w e recoil even from the descriptions o f such agon y The argument from mercy says euthanasia is justified because it provides an end to that.

The great Irish satirist Jonathan Swiff to o k eight years to die, while, in the words o f Joseph Fletcher, “H is m in d crum bled to pieces.” At tim es the pain in his blinded eyes was so intense he had to be restrained from tear­ in g them out w ith his own hands. Knives and other potential instruments o f suicide had to be kept from him . For the last three years o f his life, he could do n o th in g but sit and drool: and w h en he finally died it was only after convulsions that lasted thirty-six hours.

Swift died in 1745. Since then, doctors have learned h o w to eliminate m uch o f the pain that accom panies term inal illness, but the victory has been far from com plete. So, here is a more m od ern example.

Stewart A lsop was a respected journalist w h o died in 1975 o f a rare form o f cancer. Before he died, he wrote m o vin gly o f his experiences as a terminal patient. A lthough he had not thought m u ch about euthanasia before, he cam e to approve o f it after room ing briefly with so m eo n e he called Jack:

The th ird night th a t I room ed with Jack in our tiny double room in the solid-tum or ward o f the cancer clinic o f the N ational Institutes of Health in Bethesda, Md., a terrible thought occurred to me.

Jack had a melanom a in his belly, a malignant solid tum or th a t the doctors guessed was about the size of a softball. The cancer had started a few m onths before with a small tu m o r in his left shoulder, and there had been several operations since. The doctors planned to remove the softball-sized tumor, but they knew Jack would soon die. The cancer had metastasized—it had spread beyond control.

Jack was good-looking, about 28, and brave. He was in constant pain, an d his doctor had prescribed an intravenous shot of a synthetic opiate—a pain-kiUer, or analgesic—every four hours. His wife spent m any o f the daylight hours w ith him, and she would sit or lie on his bed and pat him all over, as one pats a child, only more methodically, and this seemed to help control the pain. But at night, when his pretty wife ha d left (wives cannot stay overnight at the N IH clinic) and dark­ ness fell, th e pain would attack without pity.

At the prescribed hour, a nurse would give Jack a shot of the synthetic analgesic, and this would control the pain for perhaps two hours or a bit more. Then he would begin to moan, or whimper, very low, as though he didn’t want to wake me. Then he would begin to howl, like a dog. 23h eh e Et h i c a l Li f e When this happened, either he or I would ring for a nurse, and ask for a pain-killer. She would give him some codeine or the like by mouth, but it never did any real good—it affected him no more than half an aspirin might affect a man who had just broken his arm. Always the nurse would explain as encouragingly as she could that there was not long to go before the next intravenous shot—“Only about 50 min­ utes now.” And always poor Jacks whimpers and howls would become more loud and frequent until at last the blessed relief came.

The third night of this routine the terrible thought occurred to me. “If Jack were a dog,” I thought, “what would be done with him?” The answer was obvious: the pound, and chloroform. No human being with a spark o f pity could let a living thing suffer so, to no good end.

The N IH clinic is, o f course, one o f the m ost m od ern and best-equipped hospitals we have. Jack’s suffering was n o t the result o f poor treatment in som e backward rural facility; it was the inevitable product o f his disease, w hich m edical science was powerless to prevent.

I have quoted A lsop at length n o t for the sake o f indulging in gory details but to give a clear idea o f the kind o f suffering w e are talking about.

We should n o t gloss over these facts w ith euphem istic language or squea­ m ishly avert our eyes from them . For on ly by keeping them firmly and v iv ­ idly in m in d can w e appreciate the full force o f the argument from mercy:

If a person prefers— and even begs for—death as the only alternative to lingering o n in this kind of torment, only to die anyway after a while, then surely it is not im m oral to help this person die sooner. As Alsop put it, “N o hum an being w ith a spark o f pity could let a living thing suffer so, to no g o o d end.” The Utilitarian Version o f the Argument In con n ection w ith this argument, the utilitarians deserve special m e n ­ tion. They argued that actions and social policies should be judged right or w rong exclusively according to w hether th ey cause happiness or misery; and they argued that w hen judged by this standard, euthanasia turns out to be morally acceptable. The utilitarian argument m ay be elaborated as follows:

(1) A n y action or social policy is morally right i f it serves to increase the am ount o f happiness in the world or to decrease the am ount o f m is ­ ery. Conversely, an action or social p o licy is morally wrong i f it serves to decrease happiness or to increase misery.fwe 2 ns3umha n g c yhw3o3im3 231(2) The p o lic y o f killing, at their ow n request, hopelessly ill patients w h o are suffering great pain w ou ld decrease the am ount o f m isery in the world. (A n example could be Alsop’s friend Jack.) (3) Therefore, such a po licy w ould be m orally right.

The first premise o f this argument, (1), states the Principle o f UtiHty, which is the basic utilitarian assumption. Today m ost philosophers think that this principle is wrong, because they think that the prom otion o f happiness and the avoidance o f misery are not the only morally important things. Hap­ piness, they say, is only one am ong many values that should be promoted:

freedom, justice, and a respect for people’s rights are also important. To take one example: people might be happier if there were no freedom o f religion, for if everyone adhered to the same rehgious beliefs, there would be greater harmony among people. There would be no unhappiness caused w ithin fam­ ilies by Jewish girls marrying Catholic boys, and so forth. Moreover, i f people were brainwashed well enough, n o one w ould m ind not having freedom o f 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 o f rehgion, because people have a right to make their own choices.

Therefore, the first premise o f the utihtarian argument is unacceptable.

There is a related difficulty for utihtarianism, w h ich connects more directly w ith the topic o f euthanasia. Suppose a person is leading a m iser­ able life—full o f m ore unhappiness than happiness—but does not want to die. This person thinks that a miserable life is better than none at all. N ow I assum e that w e w ou ld all agree that the person should n o t be killed; that w ould be plain, unjustifiable murder. Yet it would decrease the am ount o f m isery in the w orld i f w e killed this person— it w ou ld lead to an increase in the balance o f happiness over unhappiness—and so it is hard to see how, on strictly utilitarian groimds, it could be wrong. Again, the Principle o f Utility seem s to be an inadequate guide for determ ining right and wrong.

So w e are on shaky ground i f w e rely on this version o f the argument from mercy for a defense o f euthanasia.

Doing W hat Is in Everyones Best Interests A lthough the foregoing utilitarian argument is faulty, it is nevertheless based o n a so u n d idea. For even i f the prom otion o f happiness and avoid­ ance o f m isery are no t the only morally im portant things, they are still very important. So, w h en an action or a social p o lic y w ou ld decrease misery, that is a very strong reason in its favor. In the cases o f voluntary euthanasia 232 eh e Et h ic a l Lifef T T E a f aEheT eEt t T l h T eEt eh Tiec eE lT E heE T l0T L leTEl requests it, there is n o question o f violating individual rights. That is why, regardless o f the difficulties o f the Principle o f Utility, the utilitarian ver­ sion o f the argument still retains considerable force.

I w ant n o w to present a som ew hat different version o f the argument from mercy, w h ich is inspired by utilitarianism but w h ich avoids the dif­ ficulties o f the foregoing version by not m aking the Principle o f Utility a prem ise o f the argument. I believe that the follow ing argument is sou n d and proves that active euthanasia can be justified:

(1) If an action prom otes the best interests o f everyone concerned and violates no one’s rights, then that action is morally acceptable.

(2) In at least som e cases, active euthanasia prom otes the best inter- • ests o f everyone concerned and violates n o one’s rights.

(3) Therefore, in at least som e cases, active euthanasia is morally acceptable.

It w ould have been in everyone’s best interests i f active euthanasia had b een em ployed in the case o f Stewart A lsop’s friend Jack. First, and m ost im portant, it w ou ld have b een in Jack’s ow n interests, since it w ould have provided h im w ith an easier, better death, w ithout pain. (W ho am ong us w ould ch oose Jack’s death, i f w e had a choice, rather than a quick painless death?) Second, it w ould have been in the best interests o f Jack’s wife. Her misery, helplessly watching h im suffer, m ust have b een almost unbearable.

Third, the hospital staff’s best interests w ou ld have b een served, since i f Jack’s dying had n o t been prolonged, th ey could have turned their atten­ tion to other patients w h om th ey could have helped. Fourth, other patients w ou ld have benefited, since m edical resources w ou ld n o longer have been used in the sad, p ointless m aintenance o f Jack’s physical existence. Finally, i f Jack h im se lf requested to be killed, the act w ould n o t have violated his rights. C onsidering all this, h o w can active euthanasia in this case be wrong? H o w can it be w rong to do an action that is merciful, that benefits everyone concerned, and that violates n o one’s rights?

James Rachels: The Morality o f Euthanasia 1) W ould so m eo n e in circumstances like Jack’s be better o f f dead? That is, w ou ld dying quickly and painlessly be in his best interest?

2) W hat are Rachels’s objections to the principle o f utility? D o you find them convincing?1fwe 2 n s3 umha n g c yhw3o3im3 233h@ d y u -yMo HmReMio—o oMRya – mnlJtMaf -rssMn snyt feM Jfrirfmnrma mnlJq tMafN E y cyJ mlnMM u rfe HmReMio femf rf ro m ofnyalMn mnlJtMafN F@ HmReMio Rimrto femf MJfemamorm Rmaayf 3M omr- fy )ryimfM macyaM—o nrlefo4 given that the patient requests it. D o y o u find this claim plausible? Is it possible to do som eth in g that violates som eon e’s rights even i f he or she consents to it?

5) Rachels claims that (in so m e cases) active euthanasia prom otes the interests o f everyone concerned. I f our so c ie ty were to allow active euthanasia, w ou ld this be harmful to anyone’s interests? W h y or w h y not?

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