Monday, July 4, 2011

The Ethics of Euthanasia (Part Three)

(Part One, Part Two)

This post is part of the series I’ve been doing on the ethics of euthanasia. The series is based on the essays contained in the book Contemporary Debates in Applied Ethics . As noted previously, this book is organised around “pro” and “anti” essays. We’ve already looked at the “pro” euthanasia essay by Michael Tooley. In this entry, we’ll look at the “anti” euthanasia essay by Daniel Callahan.

One thing that is immediately apparent on reading Callahan’s essay is the difference in quality between it and Tooley’s. While Tooley’s essay was relatively short, and had a tendency toward glibness, it was still well organised and contained a structured argument. I finished it with a clear sense of both Tooley’s position and his defence of that position. By comparison, Callahan’s essay is a bit of a ramble. I’ve toyed with the idea that this is purely a down to personal bias on my part — i.e. I find it to be a ramble because I’m less inclined to agree with Callahan’s position — but I don’t think this is it. I think it is genuinely less well thought-out than Tooley’s piece. Still, I’m going to try to be fair and work hard to reconstruct what I take to be Callahan’s main arguments.

To give a precis at the outset, I’d say Callahan’s primary concern with euthanasia is how its endorsement would add to the range of permissible killing and thereby create an unwelcome change in our attitudes towards life and death. This change could, in turn, have undesirable social consequences that we would be better off without.

1. The Psycho-Sociology of Suicide
Callahan begins by commenting on attitudes to suicide within modern societies. He notes that comparatively few people turn to suicide as a way of dealing with the “awfulness” of their lives, despite the fact that many people suffer from terrible physical and psychological suffering. He adds that on the rare occasions that suicide is opted for, it is usually treated as an unhappy event. Something which friends and family of the deceased regret or are displeased about.

Callahan wonders why this is. He suspects that it has to do with the fact suicide is seen a bad way of coping with hardship and that life is viewed as “better, even nobler, when we human beings put up with the pain and travail that come our way.” Suicide, he argues, violates a fundamental and rational taboo, the sanctity of life.

Callahan accepts that these observations about, what I am calling, the “psycho-sociology of suicide”, are hardly decisive objections to euthanasia. Nevertheless, he thinks they provide an enriched background perspective from which to evaluate the typical arguments offered in favour of euthanasia. He also thinks that it is important to make sense of the common sense view on these matters.

I’m not sure about either the enriched perspective or the values of common sense. I think the negative reaction to suicide generally arises when (as is usually the case) it is a young, emotionally disturbed person who takes their own life. The negative reaction is justified in these cases since these people would seem to have sacrificed a future life that could have been quite valuable to them. Whether the same negative reaction (a) exists and (b) is justified in the case of an older person suffering terrible pain due to a terminal illness is quite another matter. For instance, I’d love to see any work done on whether similar negative emotions are associated with the family members of those who make use of Dignitas. I know Terry Pratchett did a documentary on this recently but unfortunately I didn’t see it.

It would also seem important on these occasions to discriminate between the negative emotions that accompany all loss of life ( e.g. sadness about the loss of a loved one) and those that are particular to suicide. I don’t think the mere fact that people are sad about someone’s passing is sufficient to warrant the assumption that people feel an important taboo has been broken. I wish Callahan had engaged more with this issue.

2. The Social Dimension of Euthanasia
Having set out the psycho-sociology of suicide, Callahan proceeds to, in his own words, “look at” the three basic arguments offered in favour of euthanasia. They are (i) the argument from the right to self-determination; (ii) the argument from the duty of beneficence and (iii) the argument from the lack of difference between killing and letting die.

You no doubt wonder why I just made a point of quoting Callahan’s own description of what he does with these three arguments (i.e. “look at” them). The answer is that it is at this point that I feel Callahan begins to ramble. Although he does talk about the argument from self-determination, he doesn’t really engage with the three arguments (and he certainly doesn’t engage with Tooley’s arguments). Instead, he offers his own basic objection to euthanasia. I’ll take the liberty of focusing solely on that objection.

The basic objection that Callahan offers is that euthanasia is misconstrued by its advocates as a private decision (i.e. a matter of self-determination) when it is, in fact, a social decision with undesirable social consequences. Now before we getting any further into it, I think this is itself a misreading of the advocates of euthanasia. Anyone who seriously discusses personal autonomy and end-of-life decision-making is well-aware of the social dimension to these decisions - no man is an island and all that. What they typically argue is that the negative social consequences do not outweigh the value in reduced harm to the sufferer and his or her family. That claim about the balance of harms over benefits is where the dispute really lies. And I think we should be perfectly happy to entertain Callahan’s argument at this level. To do that, we’ll need to consider in more detail how Callahan justifies his claim about the sociality of euthanasia and why he thinks this leads to negative consequences.

3. Private Killing and The Doctor-Patient Relationship
As regards the sociality of euthanasia, Callahan makes an obvious point: euthanasia isn’t your typical suicide, it’s a (medically) assisted form of suicide. As such, it necessarily involves at least one other person, in this case the doctor. And the involvement of the medical practitioner is worrisome for at least two reasons.

First, the doctor-patient relationship is a confidential one, one which is governed by certain laws on privilege and privacy. There are only a few, rare exceptions to these laws. This creates a problem since, if euthanasia is to be legalised, it would need to be regulated. But if doctor-patient privilege is to be maintained, there may be no way of knowing whether or not the regulations are being observed. Callahan argues that the Dutch experience confirms the existence of this problem (more on this the next day).

Second, tradition within the medical profession has firmly opposed the use of the medical knowledge to end life. Doctors have sworn to protect life, not hasten its conclusion. Callahan thinks there is wisdom in this tradition. Medical knowledge of how to bring about death is too powerful. If endorsed by the broader community, doctors could have a questionable amount of authority over life and death decisions.

So we have, essentially, two arguments from present facts about the medical profession used to reject the legalisation of euthanasia (see how we’ve moved from the moral debate to the legal debate?). Are either of them persuasive? I have some doubts about them myself. Most obviously, I wonder whether doctors would have to be involved in these decisions. Although I didn’t mention it at the time, Tooley argued in his essay that doctors need not be involved in consulting or counseling patients contemplating euthanasia. Instead, people could be specially trained in this area. This would seem to remove many of the problems identified by Callahan. Still, it would involve a substantial change to the existing legal order, and that should not be undertaken lightly.

Another problem that Callahan identifies has to do with euthanasia and private killing. Callahan thinks that private killing, such as used to exist when duelling was an acceptable dispute resolution mechanism, is a bad thing. And so, to the extent that euthanasia reinstates private killing, it too is a bad thing.

I have my concerns about this argument as well. I certainly agree that duelling was a silly and barbaric practice, but I think there are strong disanalogies between it and euthanasia, ones that consequently lessen the persuasive force of Callahan’s argument. Consider duelling. There, the concern is to resolve a dispute between two individuals and I suspect that we abhor duelling because it is a particularly wasteful and violent way in which to resolve disputes. Particularly when we have other means of doing this that are less wasteful and violent. Contrast this with euthanasia. There, our concern is to best manage the pain and suffering experienced at the end of life and we do not always have humane ways of preventing painful death. Thus, in certain circumstances, killing (euthanasia) might be the best option. This makes it different from the duelling case.

Okay, so we’ll leave it there for now. In the final part, we’ll cover the remainder of Callahan’s article.


  1. did you catch this post?

    I'm a dualist but I don't subscribe to the substance dualist argument that you put forward in your opening post. (I don't see much evidence for existence beyond bodies) Here's my argument in favor of dualism. Planning is clearly a feature of our world. Planning requires that you treat identical units differently. If you want to build a staircase you have to treat each identical block in a different fashion. Physical law cannot build a staircase, nor can it plan anything because the laws of physics treat identical units identically.

    In order to plan you must choose which units go where. If this choice is caused by something else then it's not a choice. If this something else, say, a physical law, causes the human action, then planning cannot result because, as I said, physical laws cannot plan, they must treat all identical units identically.

    If choice therefore is uncaused and it must be uncaused then it cannot be just atoms, choice must be a force like gravity, that is to say immaterial, but it has the ability to make decisions, have intentions, etc. Choice has power to move which atoms it wants and where. But choice is limited, for example, there are certain masses which are too heavy for it to move.

    You simply cannot reconcile physicalism with a very obvious feature of our universe: planning.

  2. This comment has been removed by the author.

  3. I'm going to transfer the comment to the appropriate post.