Consent and euthanasia

I once gave an argument against euthanasia where the controversial center of the argument could be summarized as follows:

1. Euthanasia would at most be permissible in cases of valid consent and great suffering.

2. Great suffering is an external threat that removes valid consent.

3. So, euthanasia is never permissible.

But the officer case in my recent post about promises and duress suggests that (2) may be mistaken. In that case, I am an officer captured by an enemy officer. I have knowledge that imperils the other officer’s mission. The officer lets me live, however, on the condition that I promise to stay put for 24 hours, an offer I accept. My promise to stay put seems valid, even though it was made in order to avoid great harm (namely, death). It is difficult to see exactly why my promise is valid, but I argue that the enemy officer is not threatening me in order to elicit a promise from me, but rather I am in dangerous circumstances that I can only get out of by making the promise, a promise that is nonetheless valid, much as the promise to pay a merchant for a drink is valid even if one is dying of thirst.

Now, if a doctor were to torture me in order to get me to consent to being killed by her, any death-welcoming words from me would not constitute valid consent, just as promises elicited by threats made precisely to elicit them are invalid. But euthanasia is not like that: the suffering isn’t even caused by the doctor. It doesn’t seem right to speak of the patient’s suffering as a threat in the sense of “threat” that always invalidates promises and consent.

I could, of course, be mistaken about the officer case. Maybe the promise to stay put under the circumstances really is invalid. If so, then (2) could still be true, and the argument against euthanasia stays.

But suppose I am right about the officer case, and suppose that (2) is false. Can the argument be salvaged? (Of course, even if it can’t, I still think euthanasia is wrong. It is wrong to kill the innocent, regardless of consequences or consent. But that’s a different line of thought.) Well, let me try.

Even if great suffering is not an external threat that removes valid consent, great suffering makes one less than fully responsible for actions made to escape that suffering (we shouldn’t call the person who betrayed her friends under torture a traitor). Now, how fully responsible one needs to be in order for one’s consent to be valid depends on how momentous the potential adverse consequences of the decision are. For instance, if I consent to a painkiller that has little in the way of side-effects, I don’t need to have much responsibility in order for my consent to be valid. On the other hand, suppose that the only way out of suffering would be a pill whose owner is only willing to sell it in exchange for twenty years of servitude. I doubt that one’s suffering-elicited consent to twenty years of servitude is valid. Compare how the Catholic Church grants annulments for marriages when responsibility is significantly reduced. Some of the circumstances where annulments are granted are ones where the agent would have sufficient responsibility in order to make valid promises that are less momentous than marriage vows, and this seems right. In fact, in the officer case, it seems that if the promise I made were more momentous than just staying put for 24 hours, it might not be valid. But it is hard to get more momentous a decision than a decision whether to be killed. So the amount of responsibility needed in order to make that decision is much higher than in the case of more ordinary decisions. And it is very plausible that great suffering (or fear of such) excludes that responsibility, or at the very least that it should make the doctor not have sufficient confidence that valid consent has been given.

If this is right, then we can replace (2) with:

4. Great suffering (or fear thereof) removes valid consent to decisions as momentous as the decision to die.

And the argument still works.