Philosophy- Ethical Reasoning paper

November 4th, 1999

The Battle of Deaths

Terminal illnesses can be some of the more painful medical conditions a person can contract. In an effort to prematurely end the pain and suffering of a person, the option of euthanasia can be presented. Within euthanasia there exists many classifications ranging from withdrawal of treatment to the ingestion of lethal substances. The problem stated is: Is euthanasia justified for a person with a painful, terminally ill illness? The thought of anyone associating euthanasia with a medical environment is enough to start some of the world’s largest controversies in moral, ethical and medical worlds alike.

Euthanasia, as stated by the American Medical Association, or AMA, is “the intentional termination of the life of one human being by another.” (Rachels 593) The means of carrying out this ultimate end can be vastly different in nature and effect, and herein lies the controversy. Active euthanasia is the process of giving a lethal dose of a drug or using any other means to quickly terminate life, while passive euthanasia is just the cessation of treatment and letting natural causes kill. The argument lies in the justifications and ramifications for each option, as well as no euthanasia.

Position: Rachels’ argument is that doctors should use active euthanasia in situations wherever euthanasia is justified or used, such as a person with a terminal illness. I have expanded this argument to include a utilitarian perspective that includes the highest utility for all alternatives, although I may not necessarily agree with its conclusion.

Argument: The expanded argument being discussed is written as follows:

1) If, in cases of a person with a severely ill, helpless, and painful illness with no foreseeable cure, Active Euthanasia provides a higher utility than any available alternative, then in this case we ought to allow Active Euthanasia.

2) In cases of a person with a severely ill, helpless, and painful illness with no foreseeable cure, Active Euthanasia provides a higher utility than any available alternative.

3) In this case we ought to allow Active Euthanasia.

Validity and Definitions:

The above argument is valid one because it is presented in proper modus ponens form. To ease understanding of the argument, many of the terms and phrases need to be explained to show the greater meaning or extra information beyond a dictionary definition. For this argument a “severely ill, helpless and painful illness with no foreseeable cure” is defined as a terminal illness, nearing its end that causes great suffering for the person under examination with no aid available within the expected lifetime of the stated person. The AMA definition for euthanasia was given earlier as “the intentional termination of the life of one human being by another.” (Rachels, 593) This can be expanded to include the means of termination to produce the two terms active and passive euthanasia. Active euthanasia is the termination of life with a process that would kill even a healthy person such as taking an excess of certain drugs, lethal injection, and poisons. Passive euthanasia is simply removing further treatment for a patient and letting the disease/illness kill him or her. When I speak of highest utility, I am referring to the theory of utilitarianism or the most pleasure or least pain situation, in this case since any alternative yields pain, be it in differing levels, the objective is to make the pain as small as possible. Utilitarianism, analyzing pleasure minus pain, uses this calculation for all alternate scenarios to choose the correct course of action. This is what is meant by “any available alternatives”. Finally “in this case” refers to any medical situation that fits the first definition of a severely ill, helpless, and painful illness.

Justification of Premise 1:

This argument was constructed using utilitarianism because the basis of utilitarianism is pleasure and pain instead of rights, or autonomous and free will. The ultimate goal with a terminal illness is to reverse or cure it, however since we do not have this option, the reduction of suffering is the goal that we are trying to seek. If we assume that active euthanasia provides the highest utility of any available alternatives then it is morally required to permit the action that allows the highest utility to be reached. In this case that action is active euthanasia and the highest utility is to end suffering by premature termination of life. The first premise is a conditional sentence, so as a result the object is not to prove the truth of active euthanasia providing the highest utility, but to show that any action that yields the highest utility of all situations, ought to be allowed by society.

Utilitarianism provides the best basis for a moral discussion of the subject of euthanasia, unless performed out of the wishes of a corrupt individual, because there is little question of the motive for cases of euthanasia since the goal is to end suffering. The best option must be done or else yield to a lower utility and therefor less happiness. The relationship between utility and action is already defined by utilitarianism and can not be separated without changing the entire philosophy. Nevertheless, besides only the theory of utilitarianism, society ought to pursue any alternative the will result in the most utility or happiness because that is what the sum of the interests of all people are. If society were to take a different course of action from that which yields the highest total utility, people would be less happy or have greater pain. The nature of sentient and non-sentient beings alike is to avoid pain and pursue pleasure, so to purposely turn away from the greatest pleasure is to go against instinct.

Justification of Premise 2:

The second premise, which states “In cases of a person with a severely ill, helpless, and painful illness with no foreseeable cure, Active Euthanasia provides a higher utility than any available alternative”, explains how active euthanasia is the best alternative, or option, for a terminal illness patient. One of the typical cases that fit the stated argument is a patient with throat cancer where no treatment can halt any pain. “He is certain to die within a few days, even if present treatment is continued, but he does not want to go on living for those days since the pain is unbearable.” (Rachels 589). Here we have a man who will die in a short time and is in great pain. To do nothing, or allow treatment to stop, as in passive euthanasia, would cause the man the same pain as if nothing were changed, which would cause a very high disutility or greater pain. For a man in the same situation who is allowed to undergo active euthanasia, their pain will end in a determined time, death is known and all amends can be made. Looking at the utility of each situation we find for passive euthanasia that the only positive or pleasure is a moral certainty that a disease killed the man instead of machine or drug, and the negatives or pains are the great suffering that must be endured, and the inability to know when life will finally expire. The utility of active euthanasia is broken into the positives of having family members present, a known time of death, and peace of mind knowing that the pain will stop, while the negative is the pain that still must be endured until the operation is completed. Clearly if any numerical values were assigned to the different attributes the option of active euthanasia offers the most benefits or utility to any case of a painful, terminal illness patient. These utility calculations, coupled with examples show how active euthanasia provides the highest utility.

Objection to Premise 1:

When looking at euthanasia and the detriments that it can cause it is easy to see beyond the simple argument to the greater consequences and faults that the argument possesses. The first premise states that a high utility value means that society ought to do it. If society wanted to abolish the known government because it was corrupt and replace it with a self-ruling planned community because they believed it would yield the highest utility, they would be placing themselves willingly into anarchy. This example of anarchy vs. government was said in order to show that maximum anticipated happiness does not necessarily show a strong plan of action even in one case. We can not know the future, but we can attempt to calculate it. Advocates of one action may not incorporate all events into utility and as a result initial happiness can not guide society’s actions if they do not fully grasp the consequences. Therefore when we say that we ought to allow active euthanasia because it yields the highest utility it does not show that there is a direct relationship between the highest utility and the action that society should take because it does not encompass all aspect and events.

Along with the object to the conditional premise by showing the inability of utility to show a distinct action, the premise must be reexamined to identify some of the terms. The first premise said that because of high utility we ought to allow active euthanasia. If we were to define ought as the moral obligation of society instead of the identified course of action, then we would be able to see a further breakdown of the relationship between utility and ought. Once again assuming that ought is equivalent to the moral action taken, we can see that high utility does not equal moral goodness. One example of high utility and low morality is to solve world hunger by using nuclear weapons on the most populated nations or killing innocent people to cause world peace. In the example of wiping out a third world, overpopulated nations to solve world hunger, we create a higher utility since everyone that needs food can use the now extreme source of food, and the sums of pleasure and pain do not come from the third world nations since they are no longer in existence, therefore not part of the sums of happiness. Society is happy since they are all well fed and there is no overcrowding, but in order to do this we had to create a huge moral disaster. The same can be said about the killing of innocent people. If we killed innocent people to settle a land dispute, we would have world peace since no nations have any reasons for malice, but, as the previous example, we committed a moral atrocity in order to attain the highest utility. With all this being stated if we look at the argument again we can see that even though we may or may not have high utility it is not what society ought to do because it might be amoral to do so.

Objection to Premise 2:

The second premise, or the part that talks about the amount of utility active euthanasia has, also has flawed parts that must be addressed. When the premise states highest utility it is relating to the basic equation of utilitarianism, or pleasure minus pain, of all society for all alternatives. The equation can be computed for active euthanasia with a much different result since some attributes’ numerical values may have been poorly assigned or left out entirely. Active euthanasia is a very bad choice from a utilitarian perspective when examining the time period before and after the euthanasia is performed. If we were to compute this we would find pleasures of having a known time of death and less pain than living, but for pains we find that we are murdering a person even if it is out of mercy, an unnecessary death if there is a cure discovered, and the pain of knowing that the person died for no justifiable reason. Any rational person would assign numbers that in any case would result in a utility less than that of doing nothing especially if a cure or even new pain drugs are discovered.

Active euthanasia is a poor option for utility even if we assume that no new drug or therapy will be created within the lifetime of a terminally ill person. Active euthanasia is the terminating of life by killing the person with something else first. No matter which method is employed it is still murder. To give a lethal injection to a sick person is no different than giving it to a criminal for the death penalty or even a random person. The motive is the different, but the end is the same. Murder is a very large pain no matter what is on the pleasure side, both with the premature taking of life, and having a person intentionally kill another. Passive euthanasia or the process of stopping treatment is not nearly as bad. Going back to the example of a sick person, an inmate, and a random person we find that the sick person will still die, but at the correct time and because of illness, the inmate and the random person will not be affected, and will continue life as usual. The result of not allowing active euthanasia is that there is no murder, and those who should live, do live.

Rebuttal/Answer to the Objection to Premise 1

James Rachels’ argument of active euthanasia having the highest utility and as a society we ought to allow it can still be justified against the above objections by showing how the objections do not apply. The first part of the objection to the first premise that showed a relationship between utility and action stated that happiness or utility does not condone a course of action. The examples showed that high happiness could sometimes yield poor consequences. The objection is valid if, and only if, the same time frame is used, however if the entire event, not just the immediate future is taken into account, utilitarianism will not cause a poor result from high happiness. When calculating utility every part of the event and every person must be taken into account or else the calculation will be invalid. If all options and all people are calculated into the basic utilitarian equation then there is a very strong relationship between utility and what we ought to do. Since utilitarianism, when calculated correctly, does not lead to poor consequences but the happiest one for society, the relationship in the first premise of utility and ought is sound.

Changing the working definition of ought to mean the choice made by morality only destroys the relationship from utility to moral obligation if utility is not fully understood. “Justice is a name for certain moral requirements which, regarded collectively, stand higher in the scale of social utility” (Mill 43). Knowing now that justice, in regards to utilitarianism, is equivalent to moral standards, and that moral standards are placed above happiness/reduced pain we can determine that morality and utility are equivalent in any case since any reduction in morality would be a direct reduction in utility. Morality and utility are equivalent for utilitarianism, so a moral obligation can be derived from the best utilitarian alternative, and because morality obligations are linked to utilitarianism, the relationship in premise one remains stable and untarnished.

Rebuttal/Answer to the Objection to Premise 2

Medical breakthroughs happen very quickly and may lead to cures for many terminal diseases, but it also brings false hopes to those who require the breakthrough. Having a cure introduced days after a terminally ill person expires is painful regardless if the person underwent euthanasia. No person is ever assured that a cure will be introduced or even pass through the Food and Drug Administration in time to make a difference in an ill person’s life. The unlikeness of a suitable treatment developed in the remaining time of a person’s life coupled with the immense pain of their condition makes active euthanasia the highest utilitarian alternative. To have a promise of a drug that does not work or even working one would cause a person to suffer with their great pain until they are able to get the new treatment, if they are able to get the new treatment at all. This time suffering causes great such a great disutility that it is not worth living through the time where a drug might appear with the possible result of the patient expiring before it can be administered. Active euthanasia will not differ from what is planned because the only possibility is death. The great reduction in suffering and the tranquility of personal thought makes active euthanasia a higher utility than passive/no euthanasia even if there is a possible cure in the future.

Active euthanasia does not generate less of a utility than any alternative because it involves killing of a person instead of letting them die of their illness. Active euthanasia is only murder if the person receiving it does not request or want it. Because it is requested and only finishes what the human body started, it can not and is not classified as murder. Rachels brought up an example of babies born with Down’s syndrome and how the current method is to let them die. “I can also understand why other people favor destroying these babies quickly and painlessly. Buy why should anyone favor letting ‘dehydration and infection wither a tiny being over hours and days’” (Rachels 590). Any utilitarian can see that if this baby must die either by withering away or by active euthanasia, the highest utility is active euthanasia. This is in no way murder since the action of active euthanasia is that of ending suffering and not the cruel unwilling termination of life that makes up murder. Murder is the killing with malice and the stealing of life from a victim, while active euthanasia is the benevolent attempt to end pain by terminating life. These definitions are clearly not the same, and if they are not the same active euthanasia can not be murder. Since active euthanasia is not murder, the methods of terminating life do not in any way impact utility.

Conclusion

James Rachels made the argument that active euthanasia is the preferable action when a person is in great, unending pain. Objections can be made and answered on the morality of killing someone even if it is out of mercy and the possible consequences if a new treatment is discovered after euthanasia is performed. These were answered by stating that murder is done with malice, while euthanasia is done to end suffering, and that a new treatment would not be likely to occur in that timeframe. No matter what the motives are for killing someone, there is still the action of one person stopping the life of another and morally we all feel that we ought not to kill. While a new treatment may not be discovered often, it only takes one person to die needlessly before their time to show society what a mistake active euthanasia is. If any philosophical view of life or living were absolutely correct, then it is likely that all the world would be following it and society would not have to debate arguments like the one presented here. Perhaps the only answer to arguments like this is to change the way we think, not to justify our position endlessly.