Wednesday, December 23, 2015

Euthanasia from an Agnostic and from a Catholic Point of View

In my ethics classes, I have my students write a paper on euthanasia, focusing especially on the Brittany Maynard case.  They have to answer these questions:


1. Is the sort of euthanasia illustrated in Brittany Maynard's case ethical?  Is it a legitimate moral option that some people might ethically choose, or is it ethically wrong? 
2. Should this sort of euthanasia be legally recognized and approved by allowing the medical profession to participate in it, as is the case in Oregon and elsewhere (physician-assisted suicide)?

They have to write their paper as a letter to one of two made-up individuals, George Stewart or Robert Merryweather.  I role-play both of these individuals in the class.  George is a Catholic, and Robert is an Agnostic.  The students have to write to whomever is on the opposite side of the questions from themselves, or at least whomever is furthest away from their own position.  They have to explain their position to whomever they are writing to and show they why they think they are right (and therefore the other person is wrong).  They are instructed specifically to be careful to avoid begging the question in their arguments, arguing superficially, etc.  When they write this letter, I respond as either George or Robert and give them feedback, argue with them, etc., to help them to hone their arguments, understand their own assumptions better, understand the other person's assumptions better, etc., and in general to grow in their ability to critically think through the issue and to dialogue with those with whom they disagree.  They can then write back and try again, get more feedback, try again, etc., and this process lasts over the whole semester.  It's a lot of fun (and a lot of work)!

Here are the documents I've written up for both George and Robert that the students read before writing the first draft of their paper:


GEORGE STEWART'S ANSWER TO THE QUESTIONS

My answer to both questions is no. My fundamental reason for this answer is that the sort of euthanasia illustrated in Brittany Maynard's case is contrary to the objective moral law of God.

Foundations

I am a Catholic, and so I hold to the Catholic worldview. The Catholic worldview is described in great detail in the Catechism of the Catholic Church, and in a more condensed form in the Compendium of the Catechism of the Catholic Church. It is summarized in the Nicene Creed. The Wikipedia article on the Catholic Church is also helpful. We believe that there are two fundamental sources of knowledge-- reason (which refers to what God has made known to us by means of our senses and reasoning ability) and revelation (which refers to what God has made known through special messages and messengers, culminating in Jesus Christ and the revelation he has entrusted to his Church). The Catholic Church, being the church founded by Jesus Christ, has been entrusted with God's revelation and is the authoritative interpreter of it. This revelation has been preserved and expounded by the Church in two forms—in Scripture (the revelation of God written and infallible) and in Tradition (the revelation of God handed down infallibly through preaching and practice, with the interpretation of that revelation the Church is led into through the infallible guidance of the Holy Spirit). Two documents of the Second Vatican Council, Dei Verbum (especially Chapter II) and Lumen Gentium (especially #25) describe this in greater detail.

Since my answer to the questions is rooted in the assumption of the truth of the Catholic worldview, it is my responsibility, to avoid begging the question, to make a case for the truth of that worldview. I will not attempt to do so here, however, as I have already done this in the two debate documents Robert and I have written up and which you can find on your Syllabus tab in Canvas. I will simply refer you to those documents.

God, being the supreme being and the author of all creation, is the ultimate moral authority of the universe. God's viewpoint defines reality, and therefore his views of good and bad are the foundation of an objective moral law which binds all of reality. He is also, for the same reason, necessarily the supreme judge. He will ensure that good is ultimately rewarded with good, and that bad is ultimately rewarded with bad (because he loves the one and hates the other), even though, in his wisdom, he does not always bring full judgment immediately. (See the second debate document for more on these points. See also the Catechism's discussion of the moral law.)

Human laws derive their legitimacy from God's moral law. God has created human beings and the universe in such a way that human nature naturally calls for certain forms of organization among human individuals with certain authority structures that go along with them--such as organizations of family and civil society (the state). Since God is the author of the human nature that gives rise to these institutions, these institutions are ordained by God and therefore have his authority behind them. Thus, in St. Paul's language (Romans 13:1-7), the "powers that be" are ordained of God and are thus ministers of God whom we are commanded by God's moral law to obey. Since these institutions are "ministers of God," they do not have unlimited authority. They only have authority when they are legitimately fulfilling their essential functions in a manner consistent with the objective moral law of God. Essential human governments, then, are a sort of limited microcosm of God's government of the cosmos. Just as God seeks to promote the good and condemn the evil in his government of the world, so human governments ought to rule according to God's moral law, promoting what is good and hindering or opposing that which is evil in order to further the common good and the glory of God. For more, see the Catechism's discussion of civil authority. (And see below as well.)

Euthanasia is Immoral

From these fundamentals, I can provide the foundation on which my answer to the questions is based. Euthanasia, particularly the kind illustrated in the case of Brittany Maynard, is unethical because it is contrary to the moral law of God. This is discussed under the heading of the fifth of the Ten Commandments in the Catechism. Our lives belong ultimately to God, and we are to use them in his service and not as if we were the ultimate masters of them. Human lives are valuable to God, and he commands us to respect and value them and to treat them accordingly. The intentional taking of a human life is therefore forbidden. There are times, such as when one's own life or the life of someone one is bound to protect is threatened by an aggressor, when necessary and just acts required to protect life unavoidably involve the unintended side effect of ending the life of another, but this is not an exception to but an illustration of the value with which we are to value life.

The prohibition on taking human life applies to our own lives as well as to the lives of others—because the same reasons apply in both cases. Although a Naturalist may argue that our lives belong to ourselves so that we may do with them whatever we please, yet the Catholic cannot view things in this way. The Catechism summarizes the Catholic position thus:

2280 Everyone is responsible for his life before God who has given it to him. It is God who remains the sovereign Master of life. We are obliged to accept life gratefully and preserve it for his honor and the salvation of our souls. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of.

2281 Suicide contradicts the natural inclination of the human being to preserve and perpetuate his life. It is gravely contrary to the just love of self. It likewise offends love of neighbor because it unjustly breaks the ties of solidarity with family, nation, and other human societies to which we continue to have obligations. Suicide is contrary to love for the living God.

In a case like that of Brittany Maynard, the desire to end one's life, or to assist another in ending his/her life, is very understandable. The grave suffering and difficulties Brittany and her family would have had to have undergone if she had not ended her own life should not be underestimated. We should assume the best of her motivations and have great sympathy for her situation and her decision. Nevertheless, even in such a case of great suffering, suicide is not permitted. As the Catechism says (#2277), “an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.” We must remember that God is the supreme creator, the ultimately moral authority of the universe, and infinitely wise and benevolent. All the commands of his moral law, therefore, are, by definition, absolutely perfect and good and best, tending in the best manner to his glory and our welfare. Violation of God's will is intrinsically immoral. To rebel against God is to incur infinite loss and misery, while to follow him brings, in the end, the full satisfaction of perfect happiness. Although our earthly sufferings seem and indeed are in themselves very great, yet they are nothing when placed in the scale against the infinite blessedness of the glory of God which those who follow God are invited to share in for all eternity. As St. Paul put it (2 Corinthians 4:17--KJV), “our light affliction, which is but for a moment, worketh for us a far more exceeding and eternal weight of glory.” By calling our earthly sufferings “light,” Paul is not minimizing those sufferings; rather, he is exalting tremendously the blessedness of sharing in God's own infinitely blessed life.

Physician-assisted Suicide Should Be Illegal

As I mentioned earlier, the legitimacy of human laws, including civil laws, are rooted in the moral law of God. Consequently, as the Catechism puts it (#1923), “[p]olitical authority must be exercised within the limits of the moral order.” Human governments have no authority to legitimize or approve of what God has condemned and forbidden, and vice versa. If the state were to grant its citizens a right to engage medical aid in acts of suicide, it would be evaluating the value of human life in a way contrary to God's moral law. It would fail to protect life as God requires it to do.

Some might argue that it is illicit to base civil laws on God's moral law, for there should be a “separation between church and state.” This phrase tends to be highly ambiguous. If it means that the state should adopt, in effect, an Agnostic outlook and base its laws on this, it is contrary to Catholic doctrine which teaches that human societies, no less than human individuals, owe allegiance to God and to his moral law. Nor is worldview-neutrality possible in civil law (or anywhere else), for civil law is applied social ethics, and ethics is applied worldviews. Pope Leo XIII addressed this issue in great detail in his 1888 encyclical Libertas (see especially #15, #18, #20, and #21):

18. There are others, somewhat more moderate though not more consistent, who affirm that the morality of individuals is to be guided by the divine law, but not the morality of the State, for that in public affairs the commands of God may be passed over, and may be entirely disregarded in the framing of laws. Hence follows the fatal theory of the need of separation between Church and State. But the absurdity of such a position is manifest. . . .

21. This kind of liberty, if considered in relation to the State, clearly implies that there is no reason why the State should offer any homage to God, or should desire any public recognition of Him; that no one form of worship is to be preferred to another, but that all stand on an equal footing, no account being taken of the religion of the people, even if they profess the Catholic faith. But, to justify this, it must needs be taken as true that the State has no duties toward God, or that such duties, if they exist, can be abandoned with impunity, both of which assertions are manifestly false. For it cannot be doubted but that, by the will of God, men are united in civil society; whether its component parts be considered; or its form, which implies authority; or the object of its existence; or the abundance of the vast services which it renders to man. God it is who has made man for society, and has placed him in the company of others like himself, so that what was wanting to his nature, and beyond his attainment if left to his own resources, he might obtain by association with others. Wherefore, civil society must acknowledge God as its Founder and Parent, and must obey and reverence His power and authority. Justice therefore forbids, and reason itself forbids, the State to be godless; or to adopt a line of action which would end in godlessness-namely, to treat the various religions (as they call them) alike, and to bestow upon them promiscuously equal rights and privileges.

It is true that the state must sometimes tolerate some evils in order to avoid bringing on even more evils. In particular, the Catholic worldview acknowledges that, especially in our current pluralistic age, room must be made for the individual consciences of men and women in order to avoid as much as reasonably possible coercing people to go against their consciences or causing them to lack sufficient civil freedom to properly form their consciences through the seeking of truth. In order to safeguard individual consciences, then, and the ability of all to pursue their duty to seek and follow the truth, especially in our pluralistic society and age, the state must allow a reasonable freedom of conscience and religion. The Catechism discusses this under the heading of the first commandment (particularly #2104-2109), and Pope Leo XIII addresses the need for a degree of toleration within due limits in Libertas #33 and #34.

However, freedom of religion and conscience is not to be granted without limits or in a fashion contrary to the moral law of God. As the Catechism says (#2109—footnotes removed), “The right to religious liberty can of itself be neither unlimited nor limited only by a 'public order' conceived in a positivist or naturalist manner. The 'due limits' which are inherent in it must be determined for each social situation by political prudence, according to the requirements of the common good, and ratified by the civil authority in accordance with 'legal principles which are in conformity with the objective moral order.'” Although evils must sometimes be tolerated, the state, like the individual, must never “do evil that good may come” (Romans 3:8).

Particularly, tolerance of evils cannot extend to tolerance for the violation of fundamental human rights and values that give to the social order the foundation for its very existence, including the value of human life. In order to pursue their duty to seek the truth in this life (which is what liberty of conscience is all about), individuals obviously must be alive. Thus, appeals to liberty of conscience cannot adequately warrant legal acceptance or toleration of PAS (physician-assisted suicide). Pope John Paul II addressed this point in his 1995 encyclical Evangelium Vitae (footnotes removed):

Certainly the purpose of civil law is different and more limited in scope than that of the moral law. But "in no sphere of life can the civil law take the place of conscience or dictate norms concerning things which are outside its competence", which is that of ensuring the common good of people through the recognition and defence of their fundamental rights, and the promotion of peace and of public morality. The real purpose of civil law is to guarantee an ordered social coexistence in true justice, so that all may "lead a quiet and peaceable life, godly and respectful in every way" (1 Tim 2:2). Precisely for this reason, civil law must ensure that all members of society enjoy respect for certain fundamental rights which innately belong to the person, rights which every positive law must recognize and guarantee. First and fundamental among these is the inviolable right to life of every innocent human being. While public authority can sometimes choose not to put a stop to something which-were it prohibited- would cause more serious harm, it can never presume to legitimize as a right of individuals-even if they are the majority of the members of society-an offence against other persons caused by the disregard of so fundamental a right as the right to life. The legal toleration of abortion or of euthanasia can in no way claim to be based on respect for the conscience of others, precisely because society has the right and the duty to protect itself against the abuses which can occur in the name of conscience and under the pretext of freedom.

In the Encyclical Pacem in Terris, John XXIII pointed out that "it is generally accepted today that the common good is best safeguarded when personal rights and duties are guaranteed. The chief concern of civil authorities must therefore be to ensure that these rights are recognized, respected, co-ordinated, defended and promoted, and that each individual is enabled to perform his duties more easily. For to safeguard the inviolable rights of the human person, and to facilitate the performance of his duties, is the principal duty of every public authority'. Thus any government which refused to recognize human rights or acted in violation of them, would not only fail in its duty; its decrees would be wholly lacking in binding force".

In #68-73 of the same encyclical, Pope John Paul II considers those who would claim that the value of protecting life is a relative value that can be overbalanced by other concerns, such as respect for majority opinion, or fear of the social repercussions of making abortion or euthanasia illegal, and he concludes that such thinking is too relativistic and does not adequately preserve the absolute and foundational nature of the right to and value of life. Since life is obviously fundamental to the social order, the devaluing of it or the overturning of its rights cannot be tolerated. John Paul II again, from the same encyclical (#72):

Now the first and most immediate application of this teaching concerns a human law which disregards the fundamental right and source of all other rights which is the right to life, a right belonging to every individual. Consequently, laws which legitimize the direct killing of innocent human beings through abortion or euthanasia are in complete opposition to the inviolable right to life proper to every individual; they thus deny the equality of everyone before the law. It might be objected that such is not the case in euthanasia, when it is requested with full awareness by the person involved. But any State which made such a request legitimate and authorized it to be carried out would be legalizing a case of suicide-murder, contrary to the fundamental principles of absolute respect for life and of the protection of every innocent life. In this way the State contributes to lessening respect for life and opens the door to ways of acting which are destructive of trust in relations between people. Laws which authorize and promote abortion and euthanasia are therefore radically opposed not only to the good of the individual but also to the common good; as such they are completely lacking in authentic juridical validity. Disregard for the right to life, precisely because it leads to the killing of the person whom society exists to serve, is what most directly conflicts with the possibility of achieving the common good. Consequently, a civil law authorizing abortion or euthanasia ceases by that very fact to be a true, morally binding civil law.

Conclusion

As the above is quite clear, I think, there is really nothing more of substance that needs to be added. I will therefore close with a summary statement of the entire subject in the form of a quotation from the Congregation for the Doctrine of the Faith (a Vatican committee designed to help the papacy and the whole Church wade through various doctrinal and ethical matters) in their (papally-approved) Declaration on Euthanasia:


It is necessary to state firmly once more that nothing and no one can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Furthermore, no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly. nor can any authority legitimately recommend or permit such an action. For it is a question of the violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity.



ROBERT MERRYWEATHER'S ANSWER TO THE QUESTIONS

My answer to both questions is yes. I do think that euthanasia, of the sort illustrated in the case of Brittany Maynard, can be an ethical option for some, and I also believe that death with dignity (doctor-assisted death such as the sort practiced in Oregon) should be legal. My main reason for thinking the way I do on these points is my conviction that our lives are ultimately our own to use as we see fit, and that death with dignity, in some rare cases, is the best option available to finish out one's life in the best way possible.

Foundations

My views on euthanasia are, of course, rooted in my broader worldview assumptions. I am an Agnostic Naturalist. I believe that, at this time, we humans do not possess knowledge of anything beyond the natural, empirical world that we inhabit and experience with our senses. I do not assert that such knowledge could never be had in principle. I won't even assert dogmatically that absolutely no one at all has such knowledge now, but I claim that if anyone does have such knowledge, it does not seem to be generally available to us. So perhaps I should say that there seems to be no publicly verifiable knowledge available to the human race at present of anything beyond the natural world. Of course, unlike George, as an Agnostic I do not have “official documents” I can refer you to to find out more about Agnosticism. Agnosticism is a substantial view regarding what we know and what we don't know, and it greatly affects how we view the world we live in, but in a sense it is a much more “negative” worldview than George's—not “negative” in the sense of “bad” but rather in the sense that it is more an affirmation of what we don't know than a list of things we do know. This makes it much easier to define. If you want to see more descriptions and definitions of Agnosticism, I would recommend the Wikipedia article on “Agnosticism” as a good basic overview, as well as Bertrand Russel's essay What is an Agnostic?

Of course, not everyone agrees with me about Agnosticism, and many non-Agnostic holders of other worldviews have claimed that their worldview can indeed be known to be true and have presented arguments attempting to show this. If I wish to avoid begging the question, then, in my claims regarding euthanasia which are rooted in my Agnosticism—and I do!—I must do something to respond to these arguments. George and I have written up a couple of debate documents (found on your Syllabus tab on Canvas) in which George has presented some of his arguments for his Catholic worldview and I have responded to them, attempting to show that they don't really prove what he thinks they prove and thus trying to establish an Agnostic position. I will not repeat my arguments here, but simply refer you to those documents.

It may be that there is more to reality than the natural, empirical world, but if there is, we don't know about it. No doubt there is much about the natural, empirical world even that we don't know. But in constructing a system of ethics and deciding how practically to live our lives, we cannot build on what we don't know but only on what we do know. If someone suggests that we ought to follow the commands of the Christian God just in case Christianity might turn out to be true, well, what if Islam, or Hinduism, or for that matter the ancient Aztec or Norse religion turns out to be true? We will simply have dug ourselves into a deeper hole, perhaps, by trying to be Christian. Of course, the religions overlap to a great extent in terms of practical advice, but then in most of the areas of overlap—such as prohibitions against murder, theft, etc.—one can reach the same conclusions on Naturalistic grounds as well and so one doesn't need to know anything about the supernatural to establish such things. When we go beyond these basic ethical principles, however, and begin to get into more specific practical commands and prohibitions of the various religions, we find that the religions differ greatly. Is it a sin to eat pork? Christianity says yes, Islam and Judaism say no, etc. Also, there are times when the historic religions of the world mostly agree on certain particular principles, but that agreement seems to be rooted more in custom and prejudice than rational consideration. Euthanasia is, I think, one of those cases. Many religions have been against it in human history, but I don't think they can show that they have had good reasons to be against it (barring belief in the supernatural claims of the religions). If human antiquity nearly agrees on something, that should give us pause and make us consider the matter carefully, but it should not determine the matter for us if the position seems to be without or contrary to reason. After all, there are many things—slavery, for instance, or lack of religious freedom, or belief in magical cures for diseases—which have been nearly unanimously thought to be OK by most human cultures in history which we now reject as irrational and not conducive to human thriving. Euthanasia has been objected to by many historic religions, but that doesn't prove they had (or have) a good reason to be against it—and not all have been against it.

At any rate, we can only work with what we have, and all we have, Agnostics claim, is what we know of the natural, empirical world. This includes our knowledge of the external, physical world as well as our knowledge of our own inner thoughts, desires, etc. George's Catholic worldview claims that there is an “objective moral law” rooted in the will of God. We were created by God and belong to him, and therefore there is a purpose for which we were made and to which we have a duty to conform. But I see no basis to claim the existence of any such “objective moral law.” What I do see is that we all have desires. We all want to be happy. There are certain things that are more conducive to making us happy, other things less conducive. Since we all want to be happy, we will want to live in such a way as to be as happy as we can be. It is out of this fact, I believe, that ethics arises. Ethics, in my view, is the art of recognizing both our desires and the relevant facts of the universe in order to find a way to live that brings about happiness and contentment. I would argue that the sorts of motivations that are natural to us include motives of self-interest, by which we seek our own personal happiness and well-being, and also motivations which embrace a concern for others—such as love, empathy, sympathy, compassion. As beings who have evolved in a social context, we are not only naturally concerned for ourselves, but we are also naturally concerned for other beings around us who we can see are like us in their capacity to experience pleasure and pain. Therefore, I would argue that, ordinarily, the best way to live the happiest life we can is to live in a way that balances self-interest with other-focused motivations. We don't want to be too selfish, and on the other hand we don't want to live as slaves to the desires of others to the point of our own misery. I could go further on this point, but instead I will refer you to an excellent little essay by Fred Edwords, The Human Basis of Laws and Ethics, which I think has argued for these points in a very compelling way. Here's another good one from Ronald Lindsay.

As social beings, we tend to live in groups and therefore require rules by which we can all attain happiness in harmonious societies. Since there is no moral law that transcends human desires, or at least none that we have any knowledge of, there is no basis for one person to have any intrinsic authority over anyone else. That is, there is no basis for me to say to you, “Because I am me, and you are you, it is inherently the case that you ought to do what I want you to do or what I tell you to do.” And vice versa. I am my own boss, and you are yours. I want my personal autonomy to be respected by others, and I'm sure you do as well. If, then, all of us want to live together in society, and we are properly motivated both by self-interest and by compassion for others, we will want to create a society that respects the autonomy of all individuals, treats all individuals equally, etc. We will want our laws and policies to be based on the consent of all the governed, and to be based on principles, ideals, and beliefs that all of us can reasonably be expected to share. We will not want to impose our own peculiar, un-objectively-verified opinions, values, and desires on each other.

John Locke, the great 17th century British philosopher, was one of the historic pioneers of the viewpoint that governmental authority must be based on the consent of the governed—usually called the social contract theory of government. Here is how he describes this position in his Second Treatise of Civil Government, chapter 8:

Sec. 95. MEN being, as has been said, by nature, all free, equal, and independent, no one can be put out of this estate, and subjected to the political power of another, without his own consent. The only way whereby any one divests himself of his natural liberty, and puts on the bonds of civil society, is by agreeing with other men to join and unite into a community for their comfortable, safe, and peaceable living one amongst another, in a secure enjoyment of their properties, and a greater security against any, that are not of it. This any number of men may do, because it injures not the freedom of the rest; they are left as they were in the liberty of the state of nature. When any number of men have so consented to make one community or government, they are thereby presently incorporated, and make one body politic, wherein the majority have a right to act and conclude the rest.

Of course, we don't want to fall into a philosophy of “mob rule,” where the majority has the power to tyrannize over minorities. We want the laws and policies of society to be based on principles all people, both majorities and minorities, can share. Here is how the great twentieth-century moral philosopher John Rawls put it in his book, Political Liberalism (New York: Columbia University Press, 1996), p. 137:

Our exercise of political power is fully proper only when it is exercised in accordance with a constitution the essentials of which all citizens as free and equal may reasonably be expected to endorse in the light of principles and ideals acceptable to their common human reason.

Therefore, we will want to avoid restricting the behavior of others except insofar as it is necessary to achieve the basic goals for society that we all share—such as the preservation of our lives from being taken away by others, preservation of personal property, and other such basic liberties and rights. This is the basis for the ideal of freedom of religion and conscience, such as is expressed in the First Amendment--”Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof . . .”--and in the Universal Declaration of Human Rights, Article 18--”Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.” It is inappropriate for a person to impose his/her religious values on other people through public laws and policies, for this would be to impose on other people without their consent, thus violating the very foundation of the social contract theory of government. Laws and policies should be based only on public reasons, not private ones—that is, reasons that are accessible to all through common human reason, not reasons that are believed only by a few because they are not fully objectively verifiable. Religious beliefs cannot be fully objectively verified, and therefore they fall into the private and not the public realm in this sense. They should not be made the basis of public laws and policies. The behavior of citizens thus should not be restricted on the basis of only private reasons, such as religious reasons. Leif Wenar shows how this would apply, for example, in the case of same-sex marriage:

To take a straightforward example: a Supreme Court justice deciding on a gay marriage law would violate public reason were she to base her opinion on God's forbidding gay sex in the book of Leviticus, or on a presentiment that upholding such a law would hasten the end of days. Not all members of society can reasonably be expected to accept Leviticus as stating an authoritative set of political values, nor can a religious premonition be a common standard for evaluating public policy. These values and standards are not public. (Leif Wenar, "John Rawls", The Stanford Encyclopedia of Philosophy [Fall 2008 Edition], Edward N. Zalta [ed.], URL = <http://plato.stanford.edu/archives/fall2008/entries/rawls/>)

Euthanasia Can Be Ethical

On this foundation, I can begin to put forward my reasons for my position on euthanasia. Here is my basic reasoning: In the vast majority of cases, it is better to live than to die. We all naturally value our own lives and wish to preserve them. Therefore, suicide is ordinarily a very irrational act. This is why we work so hard to prevent people from committing suicide, and why we regard it in such a negative way. This is all very appropriate. Obviously, our ability as individuals and societies to survive and thrive would be greatly imperilled if we ceased to care greatly about our own lives. However, in some rare cases, it seems that a person making a careful, rational, objective evaluation of his/her options may conclude that it is better to die than to live. This will be the case when the cons of continuing to live so greatly outweigh the pros that one would not reasonably be able to achieve a sufficient level of happiness to make continuing to live worth it. Brittany Maynard's case seems to me to be just such a case. Her evaluation of her options, so far as one can tell without being Brittany herself or at least someone much closer to her, seems to have been carefully and rationally conducted, and she concluded that the sufferings and difficulties which her disease and its treatments would almost certainly bring upon her and upon her family and friends were such that it was truly better for her to die than to continue to live out the rest of her limited lifespan naturally (or unnaturally, as the case may be, with all the treatments, painkillers, etc.). I can see nothing in any of the data of her case or situation that would suggest that Brittany's conclusion or decision was in any way irrational, or that she would truly have been happier continuing to live.

It is easy to claim, as some do, that her decision was irrational, and that she would have found a sufficient happiness in continuing to live. It is easy to claim this, but much harder to prove. I think we have to ask ourselves, Who was in the best position to evaluate Brittany's options and make the decision? Surely the answer is, Brittany herself. Part of the concept of our “autonomy,” as I like to call it, is that we are the masters of our own lives. We don't like it when others don't respect that fact with regard to our own lives. When I make decisions regarding how to live my life, make use of my resources, etc., I don't want to be constantly judged by others on the basis of their own desires, speculations about what is really going on in my life and inside my head, hypothetical scenarios that aren't based on any actual facts, etc. I want people to respect me and my decisions, to give me the benefit of the doubt and assume that I am a rational person capable of making rational choices regarding my own life unless there is some clear evidence to the contrary. In many cases of suicide, there is a strong degree of evidence to the contrary. If Larry says he wants to kill himself because his girlfriend broke up with him that afternoon and he is convinced that there is nothing more to live for, and he is obviously not considering the fact that these things are ordinarily gotten over, the good prospects of the future, etc., those who are in contact with Larry surely have a basis for considering that Larry is probably not evaluating his options very rationally. At the very least, they have a basis to restrain Larry until it is more clear that he is acting with his full rational capacity. We all want to be protected, not just from others, but even from ourselves in certain circumstances—insanity, debilitating medical depression or other mental disorders, etc. But Brittany's case seems obviously far different from Larry's. In a case like hers, where we cannot show some obvious irrationality, I think that proper respect for individual autonomy requires us to respect the rationality of the person's decision and his/her competence to make that decision.

Death with Dignity Should Be Legal

In a case like Brittany's where our reasonable attitude ought to be respect for the rationality of her own choice as to what to do with her own life, I think this respect extends to allowing a person the right to make use of the medical profession in carrying out his/her death if that is what he/she has chosen to do. The medical profession, like all human institutions, exists to help us live happier lives. Ordinarily, this involves trying to preserve our lives, but, as we saw above, not necessarily always. The medical profession can help a person in a case like Brittany's to die on his/her own terms in a way that is cleaner, perhaps less painful, more orderly, and in a way that can avoid the legal impediments and social stigma that (usually rightly) ordinarily attend acts of suicide.

Some would argue that doctors ought not to be allowed to aid in euthanasia, since doctors are supposed to preserve lives. Would this assisting in death, then, be contrary to their essential function? But this is too mechanical a way to view the medical profession. As I said above, the purpose of any human institution is to help us live happier lives. Of course, ordinarily doctors are in the business of preserving lives, but in those rare cases where continuing to live would truly bring more suffering than good, why should they not be allowed to provide aid by contributing their resources to helping someone end his/her life in a way more conducive to his/her happiness? I can think of no good reason.

Some people fear that allowing legalized death with dignity would inevitably lead to abuses. But I find that those who make such a claim rarely put forward specific arguments proving it in any specific way. The concern tends to be articulated merely as a vague, ominous fear, and upon investigation no rational, quantified foundation can be found for it. Oregon, and other places that allow death with dignity, place restrictions and requirements upon it to prevent abuses. If these are found to be unsatisfactory in some ways, others can be suggested. There are always some risks to any human institution, and abuses can never be wholly prevented. But we do not ordinarily ban very useful institutions for this reason alone. (If we did, we would have to ban all civil government, the medical profession in general, parenthood, etc., etc., etc.) Some of the requirements already in place in Oregon and elsewhere include things like a requirement that a person cannot have a diagnosable mental illness or depression, a requirement that a person must go through a waiting period before being able to receive aid to die, that a person must get more than one medical opinion and make the request more than once, that the doctor cannot administer the lethal drug himself, that the whole thing must be carefully documented, etc. I see no reason why, if careful regulations of this sort are in place, we need fear abuses to such an extent that we must ban medical aid in such an important area entirely.

Some people suggest that if we allow death with dignity, we will eventually be allowing doctors to kill patients at their own whims and without patient consent. But an institution based on respect for personal individual autonomy cannot logically lead to an institution based on complete disregard for individual autonomy. Sure, humans can twist anything, but if B is in truth the opposite of A it is hard to blame B on A!

Conclusion

To summarize my above arguments: Although it would clearly be irrational for most people to end their own lives, there are some people in rare cases in which, so far as I can see, it would not be irrational to do so, because the sufferings involved in continuing to live so much outweigh the pros of continuing to live. When a person in such a condition makes the decision to die and shows no clear signs of irrationality, respect for individual autonomy requires us to respect the person's decision and refrain from sitting in judgment over it by declaring it unethical (that is, irrational, not truly leading to happiness). Since the medical profession can provide significant aid to those who are in such a condition and have made such a decision, and there is no good reason not to, it makes sense to allow the resources of the medical community to be available to them, and so “death with dignity” should be legal, so long as proper regulations and safeguards are in place.