| Introduction |
Appendices |
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| Legal Cases |
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Appendix D: Phillipa Foot’s analysis of the ethics of euthanasia [i]
Introduction
Phillipa Foot defines euthanasia not only by its manner [ii] but also by the requirement that it be ‘for the sake of’ the one who dies. She takes the example of a dying torture victim who is revived so that the torture might continue, to show that there are situations where life is not a good; she then attempts to establish the grounds on which it could be judged that, for a particular individual, ‘Life is an evil’.[iii]
Her analysis falls into two parts: firstly, the search for the criteria underlying the judgement ‘Life is a good’ [summarised here in Section 1] and secondly, an examination of the conditions under which a judgement that for someone ‘Life is an evil’’ (or ‘Death is a good’) implies, if not a moral obligation to act on the basis of this judgement, at least a justification for so acting [summarised here in Section 2]. [iv]
Section 1: The criteria required for the judgement ‘Life is a good’
To Foot, the question ‘Is life a good for X?’ is equivalent to the question ‘If I were to save X’s life, would I be his benefactor?’ For example, because in reviving the torture victim so that he could be further tortured I would not be his benefactor, consequently life would not be a good for him. What are the grounds underlying the making of such a judgement?
Foot considers and rejects various possibilities:
* ‘the balance of good and evil in a life’.
This is rejected in the recognition that to refuse to rescue a person from death on the grounds that there was more evil than good in their lives, would be generally considered to be unjustified. To overcome this difficulty Foot considers a suggestion by Thomas Nagel that:
* ‘the experience of life is itself a good’ which must be brought into the equation.
This is shown not to advance the problem, as is a third suggestion that:
* ‘man’s desire for life makes it a good’.
The search for criteria to enable a judgement that ‘life is a good’ being unsuccessful, Foot then approaches the question from a different direction. She asks whether the conceptual connection between ‘life’ and ‘good’ is necessary or contingent and she seeks to elucidate the connection. Rather than seeking to tackle this problem as it applies to the human situation, she considers the relationship between the concepts of ‘life’ and ‘good’ [v] as we apply them to animals and plants suggesting that, in them, the relationship is more easily analysed without the added complication caused by considerations of the ‘balance of pain and pleasure’. [vi] Notwithstanding Foot’s belief that to speak of such balances is ‘absurd in the case of animals’,[vii] the redirection of focus does permit a more fruitful analysis. In the case of animals we would not feel that we had done anything for the animal simply by keeping it alive; this, she argues, is because such an animal would not be able to ‘operate in the normal way’.[viii] Taking this criterion of ‘normal functioning’ and returning to the human situation, Foot notes the complication added by the necessity of including the human’s view of their own situation. Should a subject’s wish for death be conclusive evidence of his life being an evil? A man might wish for death out of revenge or out of love of another even though his life was not an evil; conversely, a man’s life may be a burden to him and yet he may not wish for death. Thus, a man’s wish for death is not determinative of his life being an evil and it unclear how a man’s wishes as to his death can be incorporated into the analysis.
To summarise: Foot’s attempts to explicate the grounds for the judgement ‘Death is a good’:
* firstly, by considering some reasons often suggested as to why life is a good, and
* secondly, by attempting to widen the results of her earlier analysis of the nature of the relationship between the concepts 'life' and 'good' as applied to animals and plants, to include humans and their wishes;
were unsuccessful; her analysis faltered and she was forced to reassess her position.
A reassessment
Foot forsakes the abstract direction taken by her earlier analysis in favour of a more concrete study of those borderline cases where the normal consensus that life is a good begins to waiver. She enumerates these cases and attempts to find the principles that govern the judgements that people normally make in these matters.[ix]
The consensus that ‘life can be a good’ extends:
* to those who suffers much pain,
* to those who are severely physically handicapped,
* to those who are ‘fairly severely’ mentally handicapped such as those with Down Syndrome.[x]
However, the consensus appears to disappear when senility and severe mental disability enter the picture:
“There are some in geriatric wards who are barely conscious, though they can move a little or swallow food put into their mouths. To prolong such a state, whether in the old or in the very severely mentally handicapped is not to do them a service or confer a benefit.” [xi]
Thus, merely being alive is not a good, a
distinction must be made similar to that made in the case of animals where ‘ability to operate in an ordinary way’
was the criterion. In an attempt to
clarify this criterion Foot next considers the example of prisoners of war
living in unmerciful conditions who despite this ‘were determined to hold on’ but yet for whom ‘a bullet would have been a merciful release’.[xii] These prisoners worked every day so that the
condition that is being sought cannot be found in terms of ability to operate
in the normal way; Foot is lead to the conclusion that what makes ‘life not a
good’ for these prisoners is the lack of
a minimum of basic human goods. [xiii] Foot
then uses this criterion to reformulate her proposals.
Foot’s conclusion is that a necessary and sufficient condition for life being a good is that it contains a minimum of ‘basic human goods’. Once this basic level is achieved then life is a good, questions of the balance of pain and pleasure are irrelevant. Conversely, if this minimum is not achieved then life is not a good and questions of the balance of pleasure and pain will not reverse this judgement. However, if suffering enters into a life which is not a good then death would be a good. Thus, for example, if consciousness has sunk to such a low level as to destroy the possibility of basic human goods then such a life is - in itself - neither good nor evil; once suffering sets in then death would be a good.
Section 2: The pre-conditions required for the judgement that ‘Death is a good’ to become a justification for action.
Foot separates the questions of whether acts of euthanasia can ever be morally justified and whether such acts should ever be legalised; the first being the simpler question in that it involves consideration of the rights, interests and obligations of only the individuals concerned; the second question requires consideration of the effects on the wider society of the legalising of those acts of euthanasia which are morally justified (if such exist).
Are acts of euthanasia ever morally justified?
The key that Foot uses to unravel this
problem is the question: ‘When one man
opts for the death of another what are the grounds on which objection may be
raised?’
The grounds, she suggests, are 'Justice' and 'Charity' and these are distinct grounds.
Justice has to do with what men owe each other in the way of non-interference and positive service, it is concerned with what a man has ‘a right to’.
Charity in contrast, is a virtue which attaches to the good of others, it
is concerned with what a man has ‘a need
of ’.
Foot offers some points in clarification of the relationship between 'Justice' and 'Charity':
(i) It is possible to have an action which offends both Charity and Justice as, for example, when a man is denied what he has both ‘a right to’ and ‘a need of ’.
(ii) It is possible to have an offence against Justice but not against Charity, as in the refusal to repay a debt to an alcoholic whilst he is still drinking.
(iii) It is possible to have an offence against Charity but not against Justice, as when one refuses to rescue another if not legally obliged to do so.
(iv) Injustice may involve an act or an omission as can an offence against Charity.
Because 'Justice' is so intimately connected with rights and their infringement, Foot - in her attempt to clarify the concept of 'Justice' - is first led to clarify the concept of a ‘right’. Foot distinguishes between:
* a ‘liberty' - where no one else can demand that a person not do what he has a liberty to do e.g. to park in a public parking zone; and
* a ‘claim right’ - where in addition to the liberty to do something there is also the obligation (i.e. the ‘duty’) on others not to interfere, e.g. in parking in my private car space.
She next seeks to analyse the, so-called, ‘right to life’ by asking: “Is the ‘right to life’ ‘a liberty’, or ‘a claim right’, or a bundle of these?” Foot notes that the ‘right to life’ not only encompasses ‘right’ in the sense of ‘liberty’ but also ‘claim rights’; these latter are of considerable importance as they establish duties on others. The most fundamental of the claim rights implicit in the ‘right to life’ is the ‘right to be let alone’ and to be free from any threat by others to one’s life; this ‘right to be let alone’ is essentially a negative duty placed on others to refrain from interference in one’s life.
In addition to the ‘right to be let alone’, the ‘right to life also encompasses the right to assistance from doctors and others flowing from contract[xiv] - these are the essentially positive duties on doctors and others to provide that which they contracted to provide.
Foot’s analysis yields the most important conclusion that ‘Justice’ takes precedence over ‘Charity’; her argument for this is that otherwise the existence of the right to be let alone would be rendered null. This conclusion implies that, in discussing rights, it is a man’s wishes that are of importance not his welfare; the opinions of others as to what will be to his benefit are not relevant. So long as a man wants to live, we are not justified in killing him nor, perhaps,[xv] in deliberately allowing him to die; in particular, the duties which flow from the ‘right to life’ are not affected by the judgements of others as to the man’s ‘absolute quality of life’.[xvi]
Foot concludes that the duty of non-interference prohibits active[xvii] euthanasia. James Rachels had argued that the distinction between ‘active’ and ‘passive’ in such a context was invalid; he used the example of a child drowning in a bath and suggested that no sensible moral distinction could be drawn between the one who holds the child’s head under water and the one who refuses to rescue it. Foot’s response is that, in this example, it is not that the ‘killing’ is worse than the ‘allowing to drown’. Both are immoral but they offend against different virtues. ‘Killing’ offends against Justice, ‘allowing to drown’ against Charity.
Taking the analysis further she considers the example of a wounded soldier left by a retreating army; the soldier does not wish to be killed; however, his comrades know that he will be tortured when found by the advancing enemy. Charity requires that he be killed but Justice prohibits this; however, the withholding a life-sustaining drug would not conflict with Justice[xviii] and would be in accord with Charity.[xix]
Foot concludes:
“It is important to emphasise that a man’s rights may stand between us and the action we would dearly like to take for his sake” [xx]
Foot meets Rachels’ second argument against the distinction between 'active' and 'passive' - that it is often more humane to kill than to allow to die - by acknowledging that even though an active killing may be more humane it may infringe against Justice.
Foot concludes that when someone’s wish to die is beyond doubt then the duties of non-interference lapse and an act of euthanasia, whether active or passive, would not be contrary to Justice. However, this is not a sufficient condition; the requirements of Charity must still be considered and they may, on occasion, imply that the death which is asked for, should not be conceded as it would not be would not be ‘for the sake of’ that individual; such circumstances might occur if the person who was asked to assist in the euthanasia was strongly of the belief that the life in question was still a good.[xxi]
Should morally justified acts of euthanasia be legalised?
Though there are circumstances where active euthanasia is morally permissible, Foot argues that the calls for the legalisation of active euthanasia should be resisted principally because of the risk of creating a ‘slippery slope’. She cites the difficulty in devising procedures to ensure the consent is truly voluntary, the openness to abuse by those eager to get rid of elderly relatives and the necessity to keep intact a psychological barrier against killing, particularly so as at present, “... when people so readily assume that the life of a handicapped baby is of no value ...” [xxii]
[i] This discussion is based on Foot’s essay ‘Euthanasia’ included in her Virtues and Vices and Other Essays in Moral Philosophy, (1978).
[ii] i.e. as being ‘gentle and easy’.
[iii] The assumption that life being an evil for someone implies that death is a good for them has been criticised in Chapter 9 (Section 2 Subsection 3) where its distorting effect on Foot’s argument has been noted. Those criticism will not be repeated here where the intention is simply to summarise Foot’s argument and conclusions.
[iv] It should be noted that, for Foot, the determination that ‘X is a good for Y’ does not, of itself, imply the moral obligation to provide X for Y; the explanation for this lies in Foot’s distinction between the obligations that flow from Justice and those that flow from Charity.
[v] More accurately ‘benefit’.
[vi] ibid. p.38 (presumably based on the belief that animals cannot feel pain or pleasure though a contrary view is suggested on p.40.)
[vii] ibid. p.38.
[viii] Foot does not use the concept of 'thriving' but it is helpful in this discussion: a plant, or animal, would be killed if it was considered that it was unlikely to thrive ever again. In certain cases - for example, a household pet - such a judgement would be made ‘for the sake of the animal’. The concept of ‘thriving’ may have an applicability to the human situation with the proviso that the judgement the individual makes of his own ‘thriving’ takes precedence over all others.
[ix] [ibid. p.40]:
“We are not trying to make new judgements possible, but rather to find the principle of the ones we do make.”
[x] [ibid. p.41]:
“There are many fairly severely handicapped people - such as those with Down’s Syndrome (Mongolism) - for whom a simple affectionate life is possible. What about senility? Does this break the normal connection between life and good? Here we must surely distinguish between forms of senility.”
[xi] ibid. p.42.
[xii] ibid. p.37. This is an unsettling aspects of Foot’s analysis in that she appears to allow the judgement of an impartial bystander ‘that a life is an evil’ to overrule the judgement of the possessor of that life; the testimony of Victor Frankl on his life in a concentration camp, and the writings of Jean-Dominique Bauby who suffered from locked-in syndrome (both discussed in Chapter 7) is a reminder of an alternative perspective. (Foot’s subsequent discussion of the obligations imposed by Justice does much to restore the balance.)
Judgements such as those contemplated by Foot, are ‘absolute quality of life’ judgements, and one of the conclusion of Chapter 7 was that such judgements should not be used:
Conclusion 7 - 5 :There are at least two reasons why ‘absolute quality of life’ judgements should be rejected: they are unreliable and they are incompatible with the egalitarian principle that all persons be treated as equal. Furthermore ‘absolute quality of life’ judgements often function as a mechanism of denial so that situations which are unacceptable to the decision-maker are not permitted to continue.
[xiii] The 'goods' she has in mind are family support and companionship, freedom form hunger, hopes for the future etc.
[xiv] either an explicit or implicit contract.
[xv] If, say, as a doctor we have a contractual duty to keep him alive; Foot suggests (op.cit. p.51) that if the procedures are part of normal medical practice the patient is entitled to them however much it may be against his interest to so do.
[xvi] Unless of course this has been provided for by a ‘living will’ or otherwise.
[xvii] The distinction made by Foot between active and passive euthanasia is not that between act and omission with which it is often confused. Active euthanasia is the positive choice of a behavioural strategy - whether act or omission - which is sufficient to result in death. Thus, the killing of a man by a lethal injection and the refusal to give him a life saving drug when under a duty to do so, are both examples of active euthanasia.
[xviii] in that it is a non-interference and provided also that there was no duty implied by contract to provide it.
[xix] [ibid. p.54]:
“So, in spite of a very proper resistance to refusing to go along with the man’s own wishes in the matter of life and death, someone might justifiably refuse to prolong the life even of someone who asked him to prolong it, ... ”
[xx] ibid. p.49.
[xxi] As might happen, for example, when the individual requesting death - though rational and thus, competent - was severely depressed.
[xxii] ibid. p.58.