Thursday, December 16, 2010

An argument against euthanasia

  1. (Premise) It is wrong to euthanize a patient who does not give valid consent for euthanasia.
  2. (Premise) Valid consent is not the expression of a mental state that constitutes an abnormal mental condition.
  3. (Premise) Suicidality is an abnormal mental condition.
  4. (Premise) Consent is not valid when it comes from external threats.
  5. (Premise) A resolve to die is an instance of suicidality, unless it comes from external threats.
  6. (Premise) Consent for euthanasia is the expression of a non-threat-motivated resolve to die, unless it comes from external threats.
  7. A patient either consents or does not consent to euthanasia. (Tautology)
  8. If a patient consents to euthanasia, the consent is not valid. (2-6)
  9. Therefore, no one gives valid consent for euthanasia. (7 and 8)
  10. Therefore, it is always wrong to euthanize a patient. (1 and 9)

Presumably, defenders of euthanasia will deny at least one of 3 and 5, thereby denying that all non-threat-motivated resolves to die are abnormal mental conditions.

But now take a paradigmatic case of a suicide. Jones is a disgraced lawyer. She has gambled her clients' money and lost, driving some of her clients to suicide, and has done all sorts of other spectacularly bad things. She now thinks that because of facts about her psychological make-up, she will never again be able to hold up her head in society given how infamous her case is. And so she attempts suicide. We think we should stop her and that she is in an abnormal mental condition. But is Jones' case significantly different from that of Smith who is facing unremitting physical pain and the alleged indignity of medical treatment for the rest of her life? Suppose Jones is right that given her psychological make-up and her social environment, the rest of her life will be full of psychological pain and social indignity (including jail, which is surely more undignified than just about any medical procedure). It seems that that if we think, as we should, that Jones' resolve to die is an abnormal suicidality, we should think the same thing about Smith.

Now, we might say this. Jones is only facing unremitting psychological pain because of an underlying psychological abnormality. Normal people bounce back, and so Jones is not normal. Be that as may be, this abnormal condition of Jones stands to Jones' motivation to die in exactly the same way that Smith's abnormal physical condition stands to Smith's motivation to die. Both of them have a condition that will almost certainly render the rest of their lives miserable. That in the one case the condition is psychological and in the other case it is physical surely makes little difference. Besides, the line between the psychological and physical is hard to draw (though for some purposes a rough-and-ready distinction is helpful). A crucial part of Smith's misery will be pain, and pain is a psychological phenomenon. (And surely it makes no difference whether Smith's pain is normal or abnormal.)

Of course, there is the difference that Smith hadn't done terrible things in the past, while Jones had. But we don't stop Jones from suicide primarily because she had done wicked deeds. We stop her because that's the thing to do when someone is suicidal. And we should likewise stop Smith from killing herself, and a fortiori not help her to do so.


Eric said...

I'm not certain I understand the logic of point number 5 because causally I don't see the connection of a resolve to die being a case of suicidality.
The resolve is actually not one of dying in cases of a person suffering extreme chronic pain or associated life-threatening illness.
The wish is to end the pain and, assuming all palliative care has been duly given, if the pain could be stopped without ending their lives they would choose of course to continue living. Suicidality implies a desire to end one's life in light of all other options.

Alexander R Pruss said...

"if the pain could be stopped without ending their lives they would choose of course to continue living"

Similar things can be said about many cases of ordinary suicide. Take my example of the lawyer who cheated her clients. If the social opprobrium could be removed (e.g., by having everyone magically forget what she had done) and if she could assuage her feelings of guilt were assuaged in some way (e.g., by her having an opportunity to compensate everybody she had harmed), she would be happy to continue living.

Now, maybe, you will say that the formerly crooked lawyer isn't suicidal. But surely one of the most accurate ways of knowing that someone is suicidal is that the person is genuinely trying to kill herself. And she's doing that.

Presumably, most people who are trying to commit suicide are doing so in order to escape some evils.

Houdini said...

Interesting. I've heard recently that donating all of one's organs via euthanasia may be a thing in the future. Would donating organs to save, say, several individuals at the expense of your own life, be morally wrong? Could this be seen as a sort of sacrifice of oneself, a charitable giving of one's life to others? The first complication that comes to mind is that this may involve a consequential moral standard where the positive consequences justify the morally questionable action. And I think consequentialism isn't viable.

Alexander R Pruss said...

It's wrong to kill the innocent, even in order to give their organs to save multiple people. And I don't think it makes a difference if the innocent party is oneself.

Houdini said...

I know some people will usually argue along these lines in an attempt to justify the killing of the innocent:

One might argue that in order to justify the deliberate taking of innocent human life (J) you need to have three active necessary conditions: physical/mental suffering (S), little to no familial and societal utility (NU), and consent (C). None of these conditions are sufficient on their own to justify euthanasia, but they each serve a necessary part in a sufficient whole:

S ≠ J
NU ≠ J
C ≠ J
S + NU ≠ J
S + C ≠ J
NU + C ≠ J
S + NU + C = J

I wonder what your thoughts would be on this?

Alexander R Pruss said...

Well, I like the argument that consent is invalid in cases where great suffering is present, due to lack of responsibility. If someone cracked and revealed secrets under torture, we wouldn't hold her responsible. I also once read a very interesting argument that in order for consent to a medical procedure to be valid, the patient must be provided with medical information about what will happen to her after the procedure. But there is no medical information available about whether there is an afterlife and if so what it is like. Hence, standard informed consent rules are violated in cases of euthanasia.

Houdini said...

That's a good point. I've always found it strange how a lot of naturalists fervently push for euthanasia which, given their worldview, is a sentence to non-existence.

Would saying that consent isn't valid in cases of great suffering, therefore disallowing the medical procedure, be too broad? For instance, a man suffering from widespread cancer may be undergoing immense physical and mental suffering. Would we not consider his consent for cancer treatment valid because of his suffering?

Alexander R Pruss said...

Yeah. See this recent post.