On euthanasia: blindspots in the argument from mercy

In the euthanasia debate, the argument from mercy holds that if someone is in unbearable pain and is hopelessly ill or injured, then mercy dictates that inflicting death may be morally justified. One common way of setting the stage for the argument from mercy is to draw parallels between human and animal suffering, and to suggest that insofar as we are prepared to relieve an animal's suffering by putting it out of its misery we should likewise be prepared to offer the same relief to human beings.
In this paper, I will argue that the use of parallels between human and animal suffering in the argument from mercy relies upon truncated views of how the concept of a human being enters our moral thought and responsiveness. In particular, the focus on the nature and extent of the empirical similarities between human beings and animals obscures the significance for our moral lives of the kind of human fellowship which is not reducible to the shared possession of empirical capacities.
I will suggest that although a critical examination of the blindspots in these arguments does not license the conclusion that euthanasia for mercy's sake is never morally permissible, it does limit the power of arguments such as those provided by Rachels and Singer to justify it. I will further suggest that examination of these blindspots helps to deepen our understanding of what is at stake in the question of euthanasia in ways that tend otherwise to remain obscured.     

Is there a logical slippery slope from voluntary to nonvoluntary euthanasia?

John Keown has constructed a logical slippery slope argument from voluntary euthanasia (VAE) to nonvoluntary euthanasia (NVAE). VAE if justified implies that death can be of overall benefit, in which case it should also be facilitated in those who cannot consent (NVAE). Hallvard Lillehammer asserts that Keown's argument rests on a fallacy. However, pace Lillehammer, it can be restated to escape this fallacy. Its validity is confirmed by applying to VAE some well-established general principles of medical decision making. Thus, either VAE and NVAE must be accepted together or, if NVAE is regarded as unacceptable, VAE should also be rejected.     

Proportionality,Terminal Suffering and the Restorative Goals of Medicine

Recent years have witnessed a growing concern that terminally ill patients are needlessly suffering in the dying process. This has led to demands that physicians become more attentive in the assessment of suffering and that they treat their patients as 'whole persons.' For the most part, these demands have not fallen on deaf ears. It is now widely accepted that the relief of suffering is one of the fundamental goals of medicine. Without question this is a positive development. However, while the importance of treating suffering has generally been acknowledged, insufficient attention has been paid to the question of whether different types of terminal suffering require different responses from health care professionals. In this paper we introduce a distinction between two types of suffering likely to be present at the end of life, and we argue that physicians must distinguish between these types if they are to respond appropriately to the suffering of their terminally ill patients. After introducing this distinction and explaining its basis, we further argue that the distinction informs a (novel) principle of proportionality, one that should guide physicians in balancing their competing obligations in responding to terminal suffering. As we explain, this principle is justified by reference to the interests terminally ill patients have in restoration, as well as in the relief of suffering, at the end of life.     

Euthanasia in psychiatry can never be justified. A reply to Wijsbek

In a recent article, Henri Wijsbek discusses the 1991 Chabot “psychiatric euthanasia” case in the Netherlands, and argues that Chabot was justified in helping his patient to die. Dutch legislation at the time permitted physician assisted suicide when the patient’s condition is severe, hopeless, and unbearable. The Dutch Supreme Court agreed with Chabot that the patient met these criteria because of her justified depression, even though she was somatically healthy. Wijsbek argues that in this case, the patient’s integrity had been undermined by recent events, and that this is the basis for taking her request seriously; it was unreasonable to expect that she could start again. In this paper, I do not challenge the Dutch euthanasia criteria in the case of somatic illness, but I argue that both Chabot and Wijsbek are wrong because we can never be sufficiently confident in cases of severe exogenous depression to assist the patient in her irreversible act. This is partly because of the essential difference between somatic and mental illness, and because of the possibility of therapy and other help. In addition, I argue that Wijsbek’s concept of integrity cannot do the work that he expects of it. Finally, I consider a 2011 position paper from the Royal Dutch Medical Association on euthanasia, and the implications it might have for Chabot-style cases in the future.     

Euthanasia and John Paul II's "silent language of profound sharing of affection:" why Christians should care about Peter Singer.

Peter Singer's recent appointment to Princeton University created considerable controversy, most of it focused on his proposal for active euthanasia of disabled infants. Singer articulates utilitarian ideas that often appear in public discussions of euthanasia. Drawing on Pope John Paul II's work on ethics and suffering, I argue that Singer's utilitarian theory of value is impoverished. After introducing the Pope's ethic based on the imago dei, I discuss love as self-gift. I show how this concept supports a theory of value in which spiritual goods are preeminent over material goods. I then describe how suffering reveals spiritual goods, discussing how participation in Christ's suffering can alter our perception of value. I also consider how communal responses to suffering provide opportunities for self-giving. Third, I consider Singer's proposal for killing infants with hemophilia, arguing that it arbitrarily ignores spiritual goods. I then discuss proposals to kill anencephalic infants, discussing how parental responses to their suffering can demonstrate an extraordinary love in seemingly hopeless circumstances. I conclude by calling for a more sustained social response to euthanasia initiatives.     

Virtual augmented exercise gaming for older adults.

This paper details the design, development, and testing of virtual augmented exercise (VAE) gaming for older adults. Three versions of an underwater VAE environment were tested with a sample of 22 healthy adults aged 50 or over. Participants strongly preferred VAE to traditional physical exercise, and adherence rate was 100%. The findings suggest that VAE with puzzles changes or negates the expected negative associations among exercise outcomes. Fitness level was not associated with performance in the game, irrespective of VAE type, indicating that persons who are less physically fit can expect to perform similarly to those who are more physically fit. In conclusion, the research found some evidence for the benefits of VAE with cognitive exercise (solving simple puzzles and hitting targets based on the answer). This type of exercise appears to be a promising method of exercise for older adults.     

Sedation before ventilator withdrawal: can it be justified by double effect and called "allowing a patient to die"

...Recognizing that sedation and ventilator withdrawal have a causal impact on a patient's death does not open the door to active euthanasia but helps resist it by showing clearly where the debate centers. The heart of the euthanasia issue is not whether providers play a causal role in patients' deaths. They obviously often do when they withdraw burdensome or futile treatment or provide comfort, and these actions can be morally justified in appropriate circumstances. The key point is whether we can morally justify physicians playing two stronger causal roles: providing drugs and information for suicide and doing something in order to kill their patients. Before we can agree with those ethicists who argue that one can justify assisted suicide and active euthanasia despite the moral tradition that has shunned these causal roles, they must clearly show that the human good -- the good of the professions and of society at large, as well as the good of patients -- will be better served by physicians assisting in suicide and giving lethal injections....     

Mental Illness,Natural Death,and Non-Voluntary Passive Euthanasia

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are obligated to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not.     

Is Forgotten Evidence a Problem for Evidentialism?

The “problem of forgotten evidence” is a common objection to evidentialist theories of epistemic justification. This objection is motivated by cases where someone forms a belief on the basis of supporting evidence and then later forgets this evidence while retaining the belief. Critics of evidentialist theories argue that in some of these cases the person's belief remains justified. So, these critics claim that one can have a justified belief that is not supported by any evidence the subject possesses. I argue that these critics are mistaken.     

The last low whispers of our dead: when is it ethically justifiable to render a patient unconscious until death?

A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: (1) double-effect sedation, (2) parsimonious direct sedation, and (3) sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices are defined clearly and evaluated ethically. It is concluded that, if one is opposed to euthanasia and assisted suicide, double-effect sedation can frequently be ethically justified, that parsimonious direct sedation can be ethically justified only in extremely rare circumstances in which symptoms have already completely consumed the patient’s consciousness, and that sedation to unconsciousness and death is never justifiable. The special case of sedation for existential suffering is also considered and rejected.     

FUTILITY AND THE VARIETIES OF MEDICAL JUDGMENT

Pellegrino has argued that end-of-life decisions should be based upon the physician's assessment of the effectiveness of the treatment and the patient's assessment of its benefits and burdens. This would seem to imply that conditions for medical futility could be met either if there were a judgment of ineffectiveness, or if the patient were in a state in which he or she were incapable of a subjective judgment of the benefits and burdens of the treatment. I argue that a theory of futility according to Pellegrino would deny that latter but would permit some cases of the former. I call this the “circumspect” view. I show that Pellegrino would adopt the circumspect view because he would see the medical futility debate in the context of a system of medical ethics based firmly upon a philosophy of medicine. The circumspect view is challenged by those who would deny that one can distinguish objective from subjective medical judgments. I defend the circumspect view on the basis of a previously neglected aspect of the philosophy of medicine -- an examination of varieties of medical judgment. I then offer some practical applications of this theory in clinical practice.     

How to Argue Against Active Euthanasia

Most arguments against active euthanasia, as do most arguments in applied ethics generally, take place within the framework of what can broadly be referred to as a modern, as opposed to an ancient, approach to moral theory. In this paper, I argue that this fact works to the disadvantage of opponents of active euthanasia, and that if there is a successful argument against active euthanasia, it will be of the latter sort. In Part I, I attempt to clarify thedistinction between modern and ancient approaches with which I am concerned. In Part II, I attempt to show that any argument against active euthanasia that is of the first sort is bound to fail. In Part III, I propose an argument against active euthanasia of the second sort that I believe has a better chance for success. In Part IV, I consider some objections that can be raised against this argument and attempt to show how they can be overcome.     

Util-izing animals

ABSTRACT Biomedical experimentation on animals is justified, researchers say, because of its enormous benefits to human beings. Sure, animals suffer and die, but that is morally insignificant since the benefits of research incalculably outweigh the evils. Although this utilitarian claim appears straightforward and relatively uncontroversial, it is neither straightforward nor uncontroversial. This defence of animal experimentation is likely to succeed only by rejecting three widely held moral presumptions. We identify these assumptions and explain their relevance to the justification of animal experimentation. We argue that, even if non-human animals have considerably less moral worth than humans, experimentation is justified only if the benefits are overwhelming. By building on and expanding on arguments offered in earlier papers, we show that researchers cannot substantiate their claims on behalf of animal research. We conclude that there is currently no acceptable utilitarian defence of animal experimentation. Moreover, it is unlikely that there could be one. Since most apologists of animal experimentation rely on utilitarian justifications of their practice, it appears that biomedical experimentation on animals is not morally justified .     

The Demandingness of Confucianism in the Case of Long-Term Caregiving 1

Trends of recent demographical development show that the world's population is aging at its fastest clip ever. In this paper, I ask whether adult children should support the life of their chronically ill parents as long as it takes, and I analyze the matter with regard to the doctrine of Confucianism.

As the virtue of filial piety plays a central role in the ethics of Confucianism, adult children will face stringent demands while giving care to their chronically ill parents. In this paper, I argue that because of the extreme moral demands Confucians impose on adult children, Confucianism is an objectionable moral theory. I also argue that if Confucianism allows these agents to opt out of the caregiving tasks, it may cause conflict with its own doctrines. For these reasons, I conclude that Confucianism cannot provide a defensible response to the problem of long-term caregiving.     

What’s Wrong With Infinite Regresses?

It is almost universally believed that some infinite regresses are vicious, and also almost universally believed that some are benign. In this paper I argue that regresses can be vicious for several different sorts of reasons. Furthermore, I claim that some intuitively vicious regresses do not suffer from any of the particular aetiologies that guarantee viciousness to regresses, but are nevertheless so on the basis of considerations of parsimony. The difference between some apparently benign and some apparently vicious regresses, then, turns out to be a matter of a more general assessment of costs and benefits, making viciousness of regresses in some cases less of a local matter than is usually thought.     

‘Mutual Obligation’ and ‘New Deal’: Illegitimate and Unjustified?

It is now commonplace for governments in Western countries to require the unemployed to work in exchange for their unemployment benefits. In this article I raise some serious doubts about the most promising and philosophically interesting defence of this argument, which relies on the ‘principle of reciprocity’. I argue that it is seriously unclear whether the obligations imposed on welfare claimants by ‘workfare’ schemes are legitimate and justified according to the principle of reciprocity. I do this by reconstructing the arguments for the obligations of the unemployed put forward in both the United Kingdom and Australia.     

On Language Rights

In social and political philosophy, linguistic differences are usually seen as one item in the long and indefinite list of Cultural Differences; consequently, language rights are discussed and criticized together with other cultural rights. In this essay, it is argued that a right to use one's own language can be justified by appeal to the practical role of language in human life. The ability to communicate effectively is essential for human autonomy and well-being; thus there is no need to argue that linguistic groups, as groups, are entitled to special treatment, or that language rights are group rights. Because learning a new language is invariably a costly matter, by recognizing some languages as official languages the state (re)distributes burdens and benefits among its citizens. The task of language rights is to guarantee that these burdens are not distributed in a too unequal way.     

Critical remarks on Rawls's burdens of judgement

I examine the role of the burdens of judgement argument in Rawls's defence of the claim that liberalism cannot be based on a comprehensive doctrine. According to Rawls, the burdens of judgement make it very unlikely that most individuals can agree on anything more than a purely political morality. I argue that the argument does not succeed. I concentrate on the last three burdens which are specifically about problems of reaching normative agreement. Firstly, I argue that Rawls's claim that modern society inevitably gives rise to a diversity of values is not convincing since for every claim of divergence a counterclaim of convergence can be provided. Secondly, I provide examples of plausible agreement on partial comprehensive doctrines. Thirdly, I argue that liberalism must rely on at least one partial comprehensive doctrine, namely, the value of autonomous choice. I conclude that the burdens of judgement argument does not demonstrate that liberalism cannot be based on comprehensive moral foundations.     

Consistent Liberalism does not Require Active Euthanasia

I argue that ‘classical liberalism’ does not sanction any easy permissiveness about suicide and active euthanasia. I will use liberal arguments to argue that the distinction between active and passive euthanasia is real and that assisted suicide is, at the very least, deeply troubling when viewed from an authentic liberal perspective. The usual argument for active euthanasia is a utilitarian, not a liberal argument, as recent calls to eliminate the conscientious objection rights of doctors who refuse participation in such procedures plainly demonstrate. The paper focuses on arguments in the public sphere (such as those articulated by James Rachels).