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James Rachels and the morality of euthanasia

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Abstract

My fundamental thesis is that Rachels dismisses the traditional Western account of the morality of killing without offering a viable replacement. In this regard, I will argue that the substitute account he offers is deficient in at least eight regards: (1) he fails to justify the foundational principle of utilitarianism, (2) he exposes preference utilitarianism to the same criticisms he lodges against classical utilitarianism, (3) he neglects to explain how precisely one performs the maximization procedure which preference utilitarianism requires, (4) his account of the sanctity of life is subject to the very criticism he levels against the traditional position, (5) he cannot justify the exceptions he makes to his interpretation of the sanctity of life, (6) his account could easily be used to justify murder, (7) his embrace of autonomy as an ethical principle undermines his preference utilitarianism, and (8) he cannot maintain the moral identification of acts of killing and letting die.

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Notes

  1. The term ‘euthanasia’ as it is used in this paper will refer to the intended acts of killing a person that are performed at his or her behest, by someone other than that person. In particular, I will not examine the question of whether there is a meaningful moral difference between ‘physician assisted suicide’ or ‘medical aid in dying’ and euthanasia. Nor will I consider whether those in a persistent vegetative state or other incapacitated patients are persons, but instead will focus on the euthanizing of those who are deemed persons by all sides in the euthanasia debate. Nor will I attempt to specify which acts of killing are ‘active’ or ‘passive,’ or which means of life support or medical care are ‘ordinary’ or ‘extraordinary.’ It will only examine those acts acknowledged by all to be active means of procuring death.

  2. As is well known, utilitarian ethical theory is not homogeneous. For a good overview of the various schools of utilitarian thought see [1,2,3,4,5,6,7].

  3. Rachels’ article “Active and Passive Euthanasia,” first published in 1975, has had a significant influence on the field and has been widely anthologized and cited over 1200 times since its publication. See [8]. In addition, Rachels published two influential textbooks and anthologies which have had a significant influence on the turn from meta-ethics to more concrete ethical questions and which have sold several hundred thousand copies over the last 50 years. See [9, 10]. For a good collection of his later articles see [11]. For a critique of “applied ethics” as a discipline see [12].

  4. On classical utilitarianism and the development of preference utilitarianism see [13,14,15,16,17,18,19,20,21].

  5. For similar critiques of the sanctity of life account see [23,24,25,26]. For a critique of Singer on this point [27]. For a defense of the sanctity or inviolability of life approach see [28,29,30,31,32,33]. On the concept of dignity see [34,35,36].

  6. See [22, p. 6]. For a defense of a theologically centered approach see [37]. For a helpful analysis of Ramsey’s work see [38]. On the concept of harm see [39,40,41,42,43,44,45,46,47,48].

  7. On Schweitzer’s moral philosophy see [49,50,51].

  8. On this point see as well [52, 53]. On dignity and the ‘value of life’ see [54,55,56].

  9. Rachels critique here is similar to J.J.C. Smart’s well known critique of rule utilitarianism. See [57].

  10. On the concept of harm see as well [58,59,60,61,62].

  11. For an attempt to defend the utilitarian tradition from this type of criticism see [63].

  12. On this point see as well [64].

  13. On this point see as well [65]. For a response to Seay see [66, 67].

  14. In addition, at various points Rachels has argued that active euthanasia may actually be preferable than passive euthanasia: “If one simply withholds treatment, it may take the patient longer to die, and so he may suffer more than he would if more direct action were taken and a lethal injection given... This fact provides strong reason for thinking that, once the initial decision not to prolong his agony has been made, active euthanasia is actually preferable to passive euthanasia, rather than the reverse.” See [10, p. 79]. On this point see as well [68, pp. 281–85].

  15. On this point se as well [69].

  16. For a critique of psychological hedonism see [70].

  17. In particular, Rachels gives the examples of the troubles in Northern Ireland and the unhappiness associated with inter-denominational marriage. See [22, pp. 155–56]. In response, one could easily argue that the conflict in Northern Ireland was driven by profound social and political injustice rather than theological disagreements about scriptural interpretation, ecclesiology, soteriology, sacramental theology, and/or the nature of grace.

  18. On the shift towards preference utilitarianism in the twentieth century see [71].

  19. Unfortunately, Rachels never explains how an agent knows when to abandon reasoning and to defer to intuitions which is another significant gap in his argument.

  20. On this point see as well Rachels’ later paper [72].

  21. For a powerful example of how complicated this dynamic can be see [73].

  22. Significantly, there are times where Rachels supports violating a patients’ preference to die purportedly because dying is not in the patients’ best interests. This teleological approach however conflicts with his preference utilitarian interpretation of interests as being subjectively determined by each individual.

  23. Curiously, in the final chapter of The Elements of Moral Philosophy entitled “What Would a Satisfactory Moral Theory Be Like,” Rachels argues for an eclectic approach that borrows elements from a variety of ethical theories to create what he calls “Multiple-Strategies Utilitarianism:” “At any rate, there is some combination of virtues, motives, and methods of decision making that is best for me, given my circumstances, personality and talents – ‘best’ in the sense that it will optimize the chances of my having a good life, while at the same time optimizing the chances of other people having good lives. Call this optimum combination my best plan. The right thing for me to do is to act in accordance with my best plan” [10, p. 198]. As Christopher Lutz notes, however, “given the range of things that may be included in ‘good lives’ in contemporary culture, coupled with the flexibility of these ‘multiple strategies,’ it is difficult to see how Rachels’s ‘best plan’ differs from the relativism and subjectivism that Rachels had examined and rejected in the opening chapters of his book. The use of ‘multiple strategies’ that rely on contradictory theoretical foundations leaves the appearance that Rachels is teaching students to use the language of ethics to justify whatever decisions they have made, rather than helping them to discover a sound theoretical basis for making their decisions... we should say that Rachels’s ‘attempt to achieve a systematic understanding of the nature of morality and what it requires of us’ has been transformed... into an attempt to understand how to use the terms of morality for our own ends. By the standards set out at the beginning of Rachels’s book, his effort to understand the nature of morality has failed, and it has failed precisely because ‘the nature of morality’ that he investigates is a false subject” [74, pp. 77–78].

  24. For a good collection of articles challenging contemporary utilitarian approaches in contemporary bioethics see [75].

  25. On this point see [76, 77].

  26. For critiques of consequentialism along these lines see [78,79,80].

  27. As Gomez-Lobo notes, “in this case, what is absurd is the conclusion that sometimes one ought to do what is unjust. The conclusion is false because it is a covert contradiction. According to a universally admitted principle of justice (which, as the context shows, Smart implicitly accepts; otherwise he would not feel uneasy), it is always unjust to punish an innocent person. To claim that something is unjust, however, entails that it is something that ought not to be done. To claim simultaneously that it ought to be done generates a logical inconsistency. A way out for an act utilitarian would be to give up on the very idea that the demands of justice always ought to be satisfied. This move has unpalatable consequences however, especially for the innocent victims of injustice. If you and I were in their place, we would also demand that justice be upheld, regardless of consequences” [70, p. 116].

  28. On the ought implies can principle see [81,82,83].

  29. As Williams has argued, many would likely find cold comfort in being told he or she has lived a “moral life” after a lifetime of continual self-abnegation and abandoning everything that was meaningful and significant to us. See [1, pp. 116–117]. For this reason, J.L. Mackie has derided utilitarianism as an “ethics of fantasy.” See [84].

  30. Beauchamp and Childress offer their own example of a researcher who derives great satisfaction from inflicting pain on animals or on human subjects. As they note, this preference should be condemned and prevented from being satisfied. See [85].

  31. As Beauchamp and Childress note, “if an already prosperous group of persons could have more value added to their lives than could be added to the lives of the indigent in society, the utilitarian must recommend that the added value go to the prosperous group” [85, p. 394].

  32. For a defense of secrecy in consequentialism, see [86].

  33. For a defense of partiality see [87].

  34. In this regard, there has been considerable debate amongst utilitarian themselves as to whether one should try to produce the most good (or preference or interest satisfaction), or maximize the median amount of goodness, or some weighted function of the total good, and/or the standard deviation from the mean. For a helpful overview see [88].

  35. As Rachels notes, “Jack’s [the grandson’s] intention was honorable and Jill’s [the granddaughter’s] was not. Could we say on that account that what Jack did was right, but what Jill did was not right? No; for Jack and Jill did the very same thing” [22, p. 93].

  36. As Gomez-Lobo notes, “both a correct and mistaken calculation of the distance to the moon can produce an enjoyable state of consciousness in the astronomer if the mistake goes undetected, but surely there is value in getting it right and disvalue in being wrong, even if in both cases the subjective feeling is the same. One might object that in the long run, errors in astronomy do not produce a net balance of pleasure over pain for the astronomer, but this attitude is odd. It is unclear how the results of astronomical research should be linked to the subjective states of a particular researcher. It seems far more reasonable to say that errors should be avoided in astronomy simply because there is value in attaining astronomical truth as such” [70, p. 31].

  37. For an overview of the common law tradition on this point see [89].

  38. Singer is also uneasy in attributing the injustice involved in acts of murder to the harm suffered by the survivors rather than the victim. As he notes, “there is, of course, something odd about objecting to murder, not because of the wrong done to the victim, but because of the effect that the murder will have on others. One has to be a tough-minded classical utilitarian to be untroubled by this oddness” [21, p. 91]. Significantly, however, the survivors do not feel that the act of murder is wrong because the murderer makes them feel vulnerable. If the murderer is arrested or killed immediately after his or her act, the community still feels that a serious injustice has been perpetrated. For a further defense of the view that harm to the decedent should be central to our condemnation of homicide see [90, 91].

  39. In addition, as J.P. Moreland notes, inferring or knowing someone’s character may be difficult or even impossible for Rachels: “the inseparability of intentions and means in human action can also be seen by asking how it is possible for an action to reveal one’s character. Character is a relatively stable unity or structure of moral virtues that underlies and expresses itself in the moral acts or conduct of the person. A moral virtue is an ingrained habit or disposition of the embodied will. A habit is a disposition is a tendency to act in certain circumstances. Thus character is formed by and an expression of intentional actions. That is why one’s character is revealed by one’s actions and why actions shape character. On Rachel’s Humean analysis, actions are separate from intentions and vice versa. If that is the case, how is it that one can infer character from one’s actions? It would seem that no necessary connection exists” [92, p. 90]. It is interesting to note as well that Beauchamp and Childress have also urged such an approach in thinking through the rule of double effect. As they note, “we suggest that one constructive effort to retain an emphasis on intention without entirely abandoning the larger point of the RDE would focus on the way actions display a person’s motives and character” [85, p. 170].

  40. On this point see the comments of Dan Brock as well: “more important and perplexing, however, is how the necessary calculations can, even in principle, be made and whether the logical foundations necessary to the intelligibility of these calculations exist. Moral philosophers have paid surprisingly little attention to these two problems. Most discussions of utilitarianism in recent books and journals simply assume that it is possible to determine in any situation what is required by utility-maximization, and then go on to consider whether this always coincides with what is required by morality” [93, p. 245].

  41. On this point see [94,95,96].

  42. See [97]. While Rawls’s critique is addressed primarily towards classical hedonistic versions of utilitarianism his critique is also applicable to Rachels’s distinctive version of preference utilitarianism.

  43. With regard to this difficulty, Rachels is certainly not alone. Many other utilitarians, such as Peter Singer and Jonathan Glover, neglect the formidable task of measuring and ranking preferences or interests, as if they can develop normative principles despite this serious obstacle. One utilitarian, L.W. Sumner, might speak for many when he states comparing the utility of life and death: “The further response has been to show, in effect, that we do make such comparisons; therefore they must be possible – somehow or other” [98, p. 167]. This difficulty remains unaddressed in Sumner’s more recent work as well. See [99, 100]. On the problem of measurement see as well [101, 102].

  44. Rachels does not explicitly identify who confers value on life, but in most of his examples he claims the subject of biographical life does. Nevertheless, some ambiguity persists because in one case he supports a family member deciding the fate of a suffering sibling.

  45. See [22, pp. 154–56]. It is precisely this subjective sense of the value of life that John Harris emphasizes. Human beings are more valuable that other beings insofar as they are capable of valuing their own lives, and have the intellectual capacities to do this. According to Harris, the value of life “is the value we give to our lives” and one does this by shaping and forming one’s character through our choices and preferences [103, pp. 8–16]. For a good critique of this approach see [104,105,106]. For a defense of a form of utilitarianism that emphasizes objective well-being see [107]. In the last decade or so, Singer has also moved closer to embracing a more objective form of utilitarianism. On this point see [108].

  46. Here I would argue that something can be in an individual’s interest and thus protected by rights even if that individual does not take an interest in it. The interest need not be conscious or even then accessible to consciousness. On this point see [109].

  47. Rachels, who primarily employs the term “interest” rather than “preference” in his work, criticizes classical utilitarianism for merely trying to maximize happiness without considering an individual’s choice: “even if happiness could be increased in this way, it would be wrong to do so, because people should be allowed to make their own choices” [22, p. 155].

  48. As will be shown, at some point Rachels will have to justify exceptions to his principle, such as killing in self-defense or justified killing in wartime. For a critique of euthanasia as the impermissible killing of the innocent see [110]. On euthanasia as wrongful killing see [111, 112].

  49. Furthermore, Rachels evaluates the worth of Russell’s life in utilitarian terms that he has not justified. He concentrates on Russell’s age and concomitant inability to produce or enjoy much, or what Rachels characterizes as the “possibilities for Russell’s life.” Not only does he employ an unjustified utilitarian framework, he also contradicts the way that society views his life, or at least the intentional termination of his life. This subjectivism seems to plague most “quality of life” theories, which fail to explain society’s disapprobation of murder, regardless of the age of the victim. In addition, as David Wiggins notes, “If we ask what is so good, either absolutely or to me, about my mental life’s flowing on from now into the future, the answer... imports what makes me dear to myself – and with the idea of myself as a continuant [a substance which is a member of the natural kind ‘human being’] with certain moral or other qualities that make me fond of myself” [113, p. 152]. Commenting on this passage, J.P. Moreland and Norman Geisler summarize: “if we ask why biographical life is both possible and morally important, the answer will be that such a life is grounded in the kind of entity, a human being in this case, that typically can have that life. And the natural kind “human being” is not merely a biological notion, but a metaphysical notion which includes moral properties. Human beings have both biological and moral properties and, thus, are objects of intrinsic value simply as humans” [114, pp. 72–73].

  50. Again, because Rachels has explicitly criticized and rejected the traditional western account of the immorality of killing, he cannot use it as a basis when making exceptions to his rule that prohibits killing individuals involuntarily.

  51. On this point see [115].

  52. For a good treatment of the difficulties facing any “quality of life” approach see [116,117,118,119,120,121,122,123,124].

  53. Another difficulty that could be raised here is that Rachel’s biological vs. biographical distinction depends upon a form of Lockean or Cartesian body/self-dualism that is difficult to defend both empirically and metaphysically. A good example of this is Rachels’ claim that it is possible for a bigamist to live two distinct ‘biographical’ lives or that a person might ‘die’ and that their ‘unoccupied’ body might continue to live. This account conceives of persons as essentially minds or spirits that somehow mysteriously inhabit, possess, or occupy living biological organisms. This view also seems to have been held by John Locke. For example, see his discussions of the “Prince and the Cobbler” as well as the “Day Man and the Night Man.” In each of these cases, two distinct persons ‘inhabit’ or ‘occupy’ the same material body at different times. See [125]. Rachels is certainly not alone in holding such a view which has also been adopted (in some cases implicitly) by several others. For examples of contemporary body/self-dualism see [126,127,128,129]. Such an approach has been strongly criticized by Germain Grisez, John Finnis, Robert George, Patrick Lee, and Alfonso Gomez-Lobo amongst others. On this point see [130,131,132,133,134,135]. For a general critique of dualistic approaches see [136,137,138,139,140,141,142,143,144,145,146].

  54. As Leon Kass notes, “truth to tell, the ideal of rational autonomy, so beloved of bioethicists and legal theorists, rarely obtains in actual medical practice. Illness invariably means dependence, and dependence means relying for advice on physician and family. This is especially true with those who are seriously or terminally ill, where is frequently also depression or diminished mental capacity that clouds one’s judgment or weakens one’s mental resolve. With patients thus reduced – helpless in action and ambivalent about life – someone who might benefit from their death need not proceed by overt coercion. Rather, requests for assisted suicide can and will be subtly engineered” [147, p. 24]. On this point see as well [148,149,150,151,152,153,154,155,156,157,158,159,160,161,162]. For an attempt to address and alleviate this concern see [163, 164].

  55. On this conflict see [165].

  56. In addition, even if one does grant that a perfectly autonomous request for euthanasia has been made it is not clear at all how this honors, respects, or affirms someone’s autonomy insofar as it annihilates the very possibility of autonomous agency. As Gomez-Lobo notes, “it is clear that even an allegedly autonomous suicide is a deeply irrational action not only because of the attack on the basic human good of one’s life but because autonomy is turned against itself. Autonomy is exercised to end autonomy. It is a violation of autonomy to destroy autonomy, even autonomously. If autonomy is so valuable, we should not destroy it, either in ourselves or in others” [166, p. 71]. On this point see as well [167].

  57. On intention and side effects see Joseph Boyle: “side-effects are consequences or other aspects of one’s actions which are neither goals one seeks in action nor the precise states of affairs one is committed to realizing for the sake of those goals. They are properly regarded as outside one’s intention in acting because their occurrence does not contribute to one’s purposes; they are not part of what one wants to occur or of what, strictly speaking, serves one’s purposes.” See [168]. Ultimately, this is one of the most important differences underlying the two approaches. On double effect reasoning see [169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185]. For critiques see [186,187,188,189,190,191].

  58. On this point see as well [193,194,195,196,197,198,199,200,201].

  59. For a helpful discussion of the ordinary vs extraordinary and proportionate vs. disproportionate distinctions see [202].

  60. On this point see [203,204,205].

  61. On this point see as well Sullivan’s later response to Rachels [207].

  62. As Aquinas notes, an action is “not good simpliciter unless all the goodnesses concur.” On this point see [208]. As Ralph McInerny notes, “a single human act contains many parts which are only potentially many; some of them actually come to be separate wholes when something goes wrong” [209, p. 69]. On this point see as well [210].

  63. In particular, if the means is not suited or appropriate to the agent’s end, then the real object of his or her will may be disputed, or another end may be indicated. For instance, if someone immediately gave a potentially lethal dosage of morphine, say 300 mg, without titrating the dosage, or if someone used pancuronium bromide instead of morphine, this would likely reveal an intent to kill rather than relieve suffering. On this point see [210, 211].

  64. There are complex and difficult questions here about the nature of intention which cannot be fully addressed in this paper and will have to wait for another time. For Anscombe, what renders an act A and its consequence X intentional then is that an agent (1) has reasons for choosing act A that stem from A’s potential as a cause of X and (2) the agent wants the eventuality X. Anscombe will argue then that intending to do X entails ‘wanting’ to do X, in the motivational sense for which the “primitive sign of wanting is trying to get” [212, p. 68–70].

  65. On the question of omission see as well [213].

  66. I am assuming, of course, that there is no negligence or malice in the design or construction of the road. On this example see [214].

  67. Likewise, as Finnis notes, if this account were true then the choice to take one’s children for a walk rather than flying to Calcutta to care for homeless children would be as murderous as intentionally shooting them dead. See [132, pp. 64–65].

  68. See [215]. A well-known defense of this approach can also be found in [216]. To be fair, Singer’s criterion of comparable importance sets an important limit on sacrifice. There is a need for further argument and specification to establish what counts as a ‘comparable morally important’ good and how such goods may be precisely and accurately measured, quantified, and weighed in practical deliberation. It is not hard to see, however, how the utilitarian focus on maximization could quickly become overly demanding and would lead to actions that would more properly be considered supererogatory.

  69. In this regard, it is important to acknowledge that much of morality is outside the boundary of the law. For instance, gossiping about someone is morally wrong but it is not illegal anywhere. Nonetheless, I think a strong prima facie case can be made here that is implausible and unfair to attribute moral or legal responsibility to all the foreseen consequences of one’s actions.

  70. For a more compelling although still problematic defense see [85, pp. 188–93].

  71. For an overview of current practice in Belgium, the Netherlands, and Canada as well as emerging global trends see [217,218,219].

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Furlan, T.J. James Rachels and the morality of euthanasia. Theor Med Bioeth 45, 69–97 (2024). https://doi.org/10.1007/s11017-024-09658-2

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