Does a person have a right to die?

Note that there are two main questions:

1.     Does a person have a right to die?

a.      If no, that’s the end of the story.

b.     With Kantian ethics, it depends on how you phrase the “Categorical Imperative”

c.      Consider the categorical imperative, ‘Preserve life at all costs’ vs a more appropriate Categorical Imperative:  ‘A good agent must never directly intend the death of an innocent person’.  The first prohibits Euthanasia, the second allows it.

2.     If the answer is yes, should the person be allowed to go ahead with the procedure?

a.      That is where the PPQ comes in.

The essays below present the Kantian point of view, although not always agreeing with it.

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Killing people: what Kant could have said about suicide and euthanasia but did not

I Brassington,  J Med Ethics. Oct 2006

From: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563317/

Abstract

An agent who takes his own life acts in violation of the moral law, according to Kant; suicide, and, by extension, assisted suicide are therefore wrong. By a similar argument, and with a few important exceptions, killing is wrong; implicitly, then, voluntary euthanasia is also wrong. Kant's conclusions are uncompelling and his argument in these matters is undermined on considering other areas of his thought. Kant, in forbidding suicide and euthanasia, is conflating respect for persons and respect for people, and assuming that, in killing a person (either oneself or another), we are thereby undermining personhood. But an argument along these lines is faulty according to Kant's own standards. There is no reason why Kantians have to accept that self‐killing and euthanasia are contrary to the moral law. Even if some Kantians adhere to this doctrine, others can reject it.

Kant’s theory could be used to argue against voluntary euthanasia. Firstly, Kant would dismiss arguments concerning the suffering of the patient or the cost of treatment – these are not morally relevant factors for Kant. He is concerned with the act itself, not the consequences. Most justifications for voluntary euthanasia can therefore be dismissed.

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From: http://www.rsrevision.com/Alevel/ethics/kant/examanswer.htm

Kant would consider the maxim “It is right to kill Dianne Pretty, suffering from Motor Neurone Disease, who has asked to die”. He would then universalise it, forming a Categorical Imperative: “It is always right to kill people suffering from Motor Neurone Disease”. Kant would ask “Is this a self contradiction?” It doesn’t appear to be. “Is it a contradiction of the will?” The answer seems to be “Yes!” We couldn’t want to make a rule that meant everyone with MND had to be killed. For Kant, the universal rule is important, and individual circumstances should not be taken into consideration.

However, Kantians can put more thought into their Categorical Imperatives, and might easily form a different universal rule. For example, we might be more comfortable making a rule that said “Anyone suffering from MND who has lost the will to live, and has asked to die, should be Killed.” Put another way, we might accept a law of nature that ended life when pain became unbearable.

Kant’s theory says that people should never be merely a means to an end. You should never kill someone in order to reduce suffering, or save money. However, Kant held ‘respect for persons’ in such high esteem that allowing someone to suffer and die without dignity may seem to go against his theory. The concept of human rights does not contradict Kant’s theory, which could be used to argue for the right to die with dignity.

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Kantian vs. Utilitarian Ethics of Euthanasia...April 24, 2010

From: http://wp4dying.blogspot.com/2010/04/kantian-vs-utilitarian-ethics-of.html

 Euthanasia is often considered a moral issue. Two most famous ethicists are John Stuart Mill (1806-1873) and Immanuel Kant (1724-1804). Aside from the cultural and religious aspects on dying, Utilitarianism and Kantian Ethics discuss how we, as humans, should pursue our lives. Both theories play an important role in how one views the rights and wrongs of euthanasia.

 Mill, a British philosopher, supported the Utilitarianism perspective which is known as, "The Greatest Happiness" principle. When discussing utilitarianism in regards to euthanasia, it is safe to say that Mill is in favor of Active Euthanasia, as it ends the suffering of the person and the choice to end life is the greatest happiness for the greatest number. An additional assumption held by the Utilitarian Theory includes the pursuit of happiness. Mill believed in two classes of pleasure: higher and lower. Higher being a person's intellect and lower being the body. When a person is faced with the end of their life, it is said that we should agree that the absence of pain and the pride of the person should be taken into great consideration. When a terminally ill person is no longer capable of intellectual pursuits, is in constant pain and must rely on others for all of their needs, Mill feels that it is a more dignified choice to end the suffering, therefor fulfilling the "absence of pain" principle (pain including one's inability to seek higher pleasure through intellectual pursuit). This leads me to believe that in this case, the intention to end suffering is more meaningful than the act of euthanasia itself.

 Kant, however, provides us with a very different perspective to consider. His theories on mortality are derived from the Greek "deontology," which means obligation. Kant, often hard to understand, has many different terms for different things. The one that I see fit for euthanasia is the "Formula of the End in Itself." According to Kant's Ethics, "the more difficult the duty, the greater the moral value." This means that choosing to tough out the dying process naturally is more important than ending it at will. In addition, Kantian Ethics believe that the law should be followed to establish greater satisfaction in knowing that one has followed the law. Kantian Ethics also state that the intentions of an act are more important than the act itself. Some may fear that Kant's theory on euthanasia is that if one feels it is okay to end the life of a "competent" terminally ill patient, then society might also feel that it their duty to decide the fate of "incompetent" people who may not contribute to society, are handicapped or elderly.

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KANT AND EUTHANASIA, ANY NEXUS?

There are different arguments for and against euthanasia. What we aim to do is to outline some of these arguments and see how Kant responds to them. Kant’s response will determine if Kant is for euthanasia or against it. Arguments in support of euthanasia say that it allows people who are terminally ill to be relieved of their pain and suffering. It also allows a terminally ill person to die in dignity. Furthermore they argue that choosing when to die is personal freedom.

The response of people who feel that euthanasia is an abomination of the human being’s dignity is as follows. They hold that death is natural part of the human nature and nobody has the right to determine when to die or live not even the doctor. They say that euthanasia can be open to abuse by relatives or friends who have ulterior motives other than wish the person to get well. 

Legalization of euthanasia might lead to assaults on individual autonomy. What this implies is that if euthanasia is by chance legalized, it will be abused by a lot of persons; that is people might be placed in terrible conditions intentionally by their friends, relatives or families and then suggest to the doctor that their lives be terminated since the individual cannot function as a human being.

Now, Kant is not happy with all of these ideas that euthanasia should be legalized or encouraged no matter the situation. His first formulation of categorical imperative talks about man being a rational being; since he is a rational being, he has no right to formulate such a maxim like “if I am in a terrible condition, I have the right to take my life or reserve the right to the doctor or my family members”. This kind of maxim will not form a universal law; since it cannot form a universal law, then it should be removed and replaced with a more reasonable maxim. If we will such maxim, we will end in hypothetical imperative not categorical. Furthermore, he speaks of humanity as an end not a means to an end in his second formulation of categorical imperative. If humanity is an end, no man has the right to take his life even in whatever condition he finds himself. We must thus act in ways that do not disrespect our fellow human beings and ourselves. It will be disastrous if we act in such way as dehumanizing ourselves through euthanasia. This is the point that Kant wants us to understand.

CONCLUSION

Immanuel Kant no doubt is a unique scholar contributing to almost every branch of philosophy; even his contribution to ethical issues and to euthanasia in particular is really satisfactory. Kant believes that we are all rational men and must act as such. Rationality should define a human being from any other animal and non-living things. He demands of us to act in ways that do not contradict our very maxims that will end up being a universal law. We should know that our maxim will be treated as a universal law; this should correct whatever abstract or mundane thoughts we carry about.

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From: http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/

Dr. Ezekiel J. Emanuel, an oncologist and former White House adviser, wrote in The Atlantic that providing assisted suicide to those not suffering unbearable physical pain is a slippery slope: “Once legalized, physician-assisted suicide and euthanasia would become routine. Over time doctors would become comfortable giving injections to end life and…comfort would make us want to extend the option to others who, in society’s view, are suffering and leading purposeless lives.” He continues to say, “Physician-assisted suicide and euthanasia should not be performed simply because a patient is depressed, tired of life, worried about being a burden, or worried about being dependent. All these may be signs that not every effort has yet been made.”

“Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide. People who want to die in one of these ways tend to suffer not from unremitting pain but from depression, hopelessness, and fear of losing their dignity and control. The people they leave behind inevitably feel they have somehow failed. The answer to these symptoms is not ending a life but getting help. I have long argued that we should focus on giving all terminally ill people a good, compassionate death—not euthanasia or assisted suicide for a tiny minority.”

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EUTHANASIA - KANTIAN RESPONSE

Kant was totally opposed to taking the consequences of an action into account. The end does not in any way justify the means according to his deontological (duty-based) theory. On these grounds, euthanasia cannot be undertaken because of the benefits it will create. Any good consequences from a moral act, for Kant, had to be purely incidental to the moral action and ought to have no place in the decision regarding what action to take. In other words, if euthanasia is to take place the issue will be whether it is simply the right thing to do irrespective of any consequences for good or ill.

-        decisions based on utility (hypothetical imperatives) are not moral

-        ‘Man cannot have the power to dispose of his life’

-        C. I. ‘Preserve life at all costs’

-        Principle of Double Effect is an example of the Good Will

-        To be well informed a Kantian must consider the nature of Personhood

-        Human beings are ends in themselves

●          Kant would not agree with euthanasia if the decision to grant a request was solely concerned with hypothetical imperatives: that is, with the assessment of the benefit of the action to the patient and his/her family. In other words, the granting of euthanasia to a terminally ill patient because of pain or poor quality of life has no merit to a Kantian since these are consequential concerns. Any action undertaken with the sole intention of killing a patient because they are a burden on their family or on NHS resources would go against Kantian principles – especially the principle of the good will.

●          With regard to human life Kant stated: ‘Man cannot have the power to dispose of his life’. Kant came to this conclusion because he saw a relationship between freedom and rationality. We can go even further and say that, for Kant, freedom and rationality coincide (are the same). Put simply, Kant believed that it would be irrational for a human being to use his freedom to dispose of his freedom. In other words, to use life to dispose of life was, in Kant’s eyes, a contradiction: it is the most ‘un-human’ (‘inhuman’) act possible. Therefore, a request for euthanasia is an assault on reason itself which is, according to Kant, the foundation of the moral life (and the foundation of humanity). It is clear that Kant would argue against any act of ‘active’ or ‘direct’ euthanasia that sought after, or allowed, the deliberate death of a patient. This is why Kant and Mill come to different conclusions with regard to the use of human freedom. Freedom, according to Mill, is a property right (‘over himself, over his own body and mind, the individual is sovereign’); and because it is a human possession then it can be disposed of. The mentality here is, ‘It’s mine, so I can do with it what I like!’ In this way, the disposal of freedom (life) can be seen as a distinctive mark of humanity! By contrast, freedom, for Kant, is a duty to uphold at all times, and therefore it would be a contradiction to dispose of one’s freedom through a deliberate act of euthanasia. (In this way, the refusal of ‘active’ or ‘direct’ euthanasia can be seen as a distinctive mark of humanity!)

●          It is absolutely clear from the above discussion that Kant has a high regard for human freedom (autonomy), but that a person’s right to exercise freedom over one’s own body must take second place to a person’s duty to be rational. To be rational, in the euthanasia debate, means that a Kantian has a duty to be well informed about the issue so that they can make decisions based on universal principles and not succumb to decisions based on selfish desire or self-interest. Each decision must, in other words, be an example of the Good Will. Secondly, a Kantian must investigate such concepts as personhood in order to help them make rational decisions regarding patients who are perhaps in a permanent coma or PVS. Why personhood? Because, according to Kant, the capacity for rationality defines what it means to be a human person. Both these aspects, (i) the good will and (ii) personhood, will be considered below.

●          Consider the categorical imperative, ‘Preserve life at all costs’ Making this a universal rule would make euthanasia wrong without exception, since it appears to fit the three tests of a universal: (1) ‘What if everyone did that?’ (2) ‘Is it logically (not actually) possible for everyone to do it?’ (3) ‘Do you rationally want everyone to do it?’ No one would be killed, but also no one would be allowed to die. A human being would only die because of their underlying condition e.g. their terminal illness no direct intervention would be acceptable; it may even be argued by strict Kantians that morphine should not be used because of its effect in shortening life. Furthermore, those who are deemed to be alive only at the biological level – only respiration and circulation – would have to be kept alive by all means irrespective of any improvement since all that matters is following the imperative. Yet this imperative cannot be a truly universal categorical imperative, because it fails to take into account two things: (i). an action must be an example of the Good Will. This means that the reason why something is done is, for Kant, as important as what is done. In other words, like the Church, Kant is concerned with the intention (will) of an action; he’s interested in why we do things. (ii). secondly, ‘preserve life at all costs’ fails to take into account one’s duty to be rational. How do these two ideas relate to the issue of euthanasia?

- the good will – The Principle of Double Effect is an example of the Good Will - the point of the ‘good will’, for Kant, is that people should do the right thing with the right intention. So Kantians would be against any act of euthanasia which may bring benefit to the patient’s relatives or to the NHS in terms of the saving of scarce resources because these would be seen as examples of self-interest. However, if you act with the right intention (not out of selfish desire or self-interest) then Kantians will recognise the distinction between ‘killing’ and ‘letting die’ as something morally significant. So in agreement with the Christian Church and against utilitarianism, Kant would recognise that there is a valid distinction between deliberately bringing about death and allowing death. For example, if the deliberate intention is to ease pain and death comes about as a foreseen but unintended consequence then a Kantian will accept this since they see it as acting with the right intention. Some may say that this is an example of ‘passive euthanasia’, but a Kantian would say, in agreement with the R.C. Church and C of E that it is an example of the Principle of Double Effect. This creates a more appropriate Categorical Imperative: ‘a good agent must never directly intend the death of an innocent person’.

- duty to be rational – To be Well Informed a Kantian must consider the nature of Personhood. By ‘duty to be rational’ Kant means that an action should be completely objective – decisions should be informed by the use of reason alone, and not be subjective - influenced by selfish desire or self-interest (i.e. an example of the ‘good will’). In practice this will mean that there ought to be an investigation into the personhood of the patient that is not influenced by the personal (subjective) motives of family members or doctors. In cases like permanent coma and PVS judging a patient’s capacity for rationality is central because, according to Kantians, rationality is the measure of personhood. In the case of a permanent comatose or PVS patient a Kantian would consider that the human being who is kept alive by artificial nutrition is not a person, since their life has only one dimension, that of biological life – the major characteristics of personhood are absent. Consequently, a Kantian would agree that a patient in such circumstances be allowed to die. Kantians may also agree to ‘active euthanasia’ – the administration of a lethal injection – because such patients who are in permanent comas or PVS lack true humanity because they lack rationality. Such action would not contradict the Categorical Imperative: ‘a good agent must never directly intend the death of an innocent person’, because the patient is not a person.

●          human beings are ends in themselves. It would be wrong, according to Kant, to treat a terminally ill patient as a means only. So any act of euthanasia done with the sole intention of removing the drain on NHS resources or to end the agony of relatives would be wrong. A patient would be treated as an end-in-themselves if it was decided to allow them to die in order to avoid disproportionate or burdensome treatment. While this would be a means of saving NHS resources and relieving the agony of relatives, the patient is primarily being treated as an end because the deliberate intention of the withdrawal of treatment is to avoid unnecessary suffering. Yet a Kantian may, in good conscience, treat a permanently comatose or PVS patient as a means to an end alone if it is believed they are on longer rational (truly human), because to those who ‘are not self-conscious we have no direct duties’.