Unit 5 DB: Justifiable Suicide Americans are living longer than ever before, living with chronic pain and suffering that might not, at least for some, make that life worth living. The example of Admir

9.1: The Taking of Human Life

1. 9.1 Relate the value of life principle to the ethics of taking of human life

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One of the worst possible moral offenses that a human being can commit is the taking of another human’s life. The Value of Life Principle is empirically the most important, inasmuch as morality itself depends on it; therefore, one must revere life and accept death. Does this mean that human life may never be taken? We will examine different types of situations involving the taking of human life and see how basic principles can be applied to them.

1. 9.2 Compare the arguments for and against suicide

In order to better understand the definition of suicide, it will be useful to first reexamine the definitions of killing and murder. Killing means “to put to death, slay, deprive of life,” whereas murder means “the unlawful killing of one human being by another, especially with malice aforethought.” Suicide is defined in the same dictionary as “an intentional taking of one’s own life.”1 Under this definition, the act of suicide certainly involves both killing and the taking of a human life, but it is extremely difficult to justify the argument that it involves murder. Furthermore, suicide is not generally considered civilly or criminally unlawful in most states and countries because it involves the taking of one’s own life, not the life of another; it is a decision made by people about their own lives based upon their own thoughts and feelings.

One of the most common arguments against the morality of suicide is the one that suggests that all people who attempt or commit suicide are irrational or mentally or emotionally disturbed, a viewpoint characterized by the statement “No one in his right mind would commit suicide.” This argument further states that because suicide is never a rational act, it can never be considered as anything but immoral. The problem with this assumption is that it is too all-encompassing, as are, for example the theories of psychological egoism and hard determinism.

Many people who intend to commit suicide often leave calm, well-written letters explaining why they decided to commit suicide. It also has been noticed, by many of the families after the suicide has occurred, that there was calm and contentment just before the person committed suicide. In fact, families are often surprised, given the fact that the suicidal person was emotionally and mentally troubled and upset for most of his or her life, that just before he or she committed suicide that person seems to have been at peace. This might suggest that the suicidal person had found what he or she deems a “rational” way of solving his or her problems. Is this so irrational even if one does believe suicide to be wrong?

In another example, Socrates (ca 470-399 B.C.E.), who was condemned to death by his peers, was urged to escape and had every opportunity to do so. Instead, he chose to drink hemlock, a poison. Before he committed this act, he rationally discussed his decision with his students and friends, a conversation dramatized in Plato’s dialogue Crito. Anyone who reads this dialogue will be hard put to say that Socrates was irrational in any sense of the word. One may not agree with Socrates’s arguments or with his final decision, but it would be difficult to question the soundness of his mind. In any case, the argument that suicide is an irrational act, though sometimes valid, cannot be used to declare all suicides immoral, for it cannot be proven to be true in all cases.

Various religions are opposed to suicide because they believe that only God has the authority to give and take away life; human beings are only loaned their lives to be lived as well, morally and religiously, as they can. Religions certainly are entitled to this belief, and they may require that their members adhere to it by not committing suicide, but in no way can this view be imposed upon nonmembers, religious or nonreligious, without some violation of the principles of Freedom and Justice.

This theological problem applies to all aspects of the taking of human life, not just suicide; therefore, it would be good to keep this problem in mind as we deal with the other issues in this area.

People who hold to “the domino argument” believe that if you allow human life to be taken in some instances, you open the door to its being taken in other instances and, eventually, in all instances. Like the religious argument, the domino argument also applies to areas of the taking of human life other than suicide. Furthermore, it is a good argument to be aware of when we are discussing any moral issue, because it forces us to be concerned about the effects of our moral decisions or laws. For example, if we argue that suicide is moral, then we should be concerned with where this position will lead us: Will murder be made moral next? Or if suicide is morally permitted, then why not mercy killing and abortion?

Even though it is important for us to try to gauge the effects of our rules and actions, where there is no definite or conclusive proof that one thing necessarily leads to another, we cannot use this argument as the sole reason for not allowing an act or person to be declared moral or immoral. And there is no conclusive proof that if suicide is allowed, murder soon will be allowed as well. Most states and countries have laws against capital punishment, abortion, mercy killing, and of course, murder.

The Justice Argument

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Probably the most effective case against the morality of suicide is made by those who argue that the people who survive a person who has committed suicide pay an unjust penalty:

1. A husband or wife may leave behind a despondent and destitute spouse and grief-stricken children.

2. Sons and daughters may leave guilt-ridden parents.

3. Society may be denied the important contributions that could have been made by the person who committed suicide.

This is an argument that must be carefully considered, for it involves the Principle of Justice, which, in the matter of suicide, conflicts with the Principle of Individual Freedom. This is a conflict that must be dealt with as one attempts to decide whether suicide is moral.

Journal: Views on Suicide

What is your moral position on the issue of suicide? How would you justify this stance?

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The basic argument in favor of suicide as a moral act has to do with a person’s rights over his or her own body and life. It is also concerned with the freedom of a person to make decisions affecting his or her own body and life.

The Principle of Individual Freedom is important here, of course, and so is the Principle of Goodness. Suicide is such a private act that only the person who is considering it can know to any degree whether continuing to live would bring her more satisfaction, excellence, or harmony than ending her life. This argument stresses that individuals are unique and that only they know whether or not their lives are worth living; therefore, only they should be able to make decisions concerning whether they live or die. According to this argument, a decision to commit suicide may be considered rational, provided that a person’s reasoning faculties are not impaired by severe mental or emotional disturbances. Even when they are in perfect mental health, however, people who successfully commit suicide should not be blamed for being immoral nor should people who attempt suicide be blamed or punished in any way.

The main criticism of the morality of suicide, other than those presented in the arguments against suicide we have already discussed, is that it tends to imply that people have absolute rights over their own bodies and lives. In other words, it suggests that the Principle of Individual Freedom has no limitations, an implication that can raise some difficult problems.

For example, if a man has a highly contagious disease and doesn’t want to be placed in quarantine because it will limit his freedom over his own body and life, his freedom must nevertheless be restricted. Otherwise, he could be responsible for the sickness and death of many other innocent people. That is, because of the priority of the first four basic principles, his freedom to do what he wants with his body and his life must be curtailed. In a similar manner, when a person’s contemplated suicide will definitely affect the lives and welfare of others (e.g., his dependents), questions must at least be raised concerning the possible limits of the person’s freedom over his own body and life.

Generally speaking, neither the arguments for nor those against the morality of suicide advocate the taking of one’s own life, and most people on either side probably would urge the use of all possible means to prevent people from killing themselves. However, the side supporting the morality of suicide would most likely make greater allowances for individual decision making. For example, those who feel suicide is always immoral might advocate the imposition of physical and legal restraints upon people who are known to be suicidal, whereas people who believe that suicide is a moral act will try to prevent people from committing suicide but will not use force in attempting to deny them the freedom to make their own rational decisions.

William, 60, has had inoperable cancer for several months, and it is now in the terminal stages. He is unwilling to go to a hospital or a hospice and lives unhappily at home. Everything about living has lost its savor: He no longer enjoys eating, drinking, smoking, or any of his other former pleasures. He has made a will and taken care of all unfinished business. Finally, he confronts his wife and two teenage children with his wish to commit suicide—to die with dignity, as he expresses it, rather than linger on and become increasingly ill. His wife and children don’t like the idea, but they agree with him that the choice is his. He shoots himself and dies.

Joan, 18, has lived in one foster home after another ever since she was born. She has been in and out of mental institutions, having been treated for extreme depression. She has used drugs but is not using them now. Having become pregnant twice, she has had two abortions. She feels she has no real friends, she has no parents to relate to, and she can’t concentrate on school or work. Although she has talked to several psychiatrists and psychologists, she doesn’t feel any better about herself or her life. She finally decides, calmly, that she is tired of living. She takes an overdose of barbiturates without leaving a suicide note or telling anybody what she is going to do, and dies.

1. 9.3 Use the value of life principle to establish that the taking of human life is always wrong

Equally as challenging as the debate over the morality of suicide is the question of killing in defense of the innocent. This is a multi-layered issue that balances the Value of Life Principle on the one hand, against the need to protect the life of an innocent on the other.

There is really only one argument against killing in defense of the innocent, and that is based on the assumption—held by the adherents of a few ethical systems (Pacifists, Jainists, Kantian Duty Ethicists)—that the taking of human life is always wrong. This position is the most consistent one possible in terms of the Value of Life principle because it respects human life at all costs. According to this argument, all human life is to be revered and no one may ever be killed for any reason, even if one’s life is threatened by another. In such a case, one who is being threatened may try everything short of violence or killing to prevent being killed, but he or she may not kill another, even in self-defense or in defense of other innocent people.

To refrain from killing any humans is, of course, an admirable ideal, and it is one to which most people are able to adhere throughout their lives. The main criticism of this point of view is that it does not take into consideration all the complexities of human existence, especially the fact that some humans—fortunately a relatively small number—do not respect the lives of others. If all humans would respect human life completely, then maybe everyone could completely adhere to the ideal of not killing other humans under any circumstances. This ideal certainly is put forth in Christianity in Jesus’s teachings of “Love thy enemies” and “Turn the other cheek.” However, very few Christians or other human beings are willing to adhere to such an ideal; they simply do not feel that it is good, fair, or just for innocent people to lose their lives to killers who violate this ideal and who often cannot be stopped in any other way than by being killed themselves.

Journal: Justification of Taking a Human Life

Analyze if taking of human life for self-defense is justifiable. Give reasons for your answer.

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The argument for killing in defense of the innocent generally rests upon two assumptions: First, even though the Value of Life principle advocates a reverence for all human life, people have a right and, indeed, a moral obligation to protect innocent lives, their own included, when it becomes clear that another human being no longer recognizes the value of other people’s lives. Second, the good of defending the innocent far outweighs the bad of killing a person who is threatening to kill or who actually kills innocent people. The essence of this argument is that by threatening to kill or by killing others, killers in a sense forfeit their right to have their lives considered as valuable, especially when their acts cannot be stopped unless they themselves are killed. This argument qualifies the Value of Life principle by stating that one should never kill other humans except when defending innocent people, including oneself.

The main criticism of this argument is that violence tends to breed more violence and that once the killing of humans has been allowed, even in defense of the innocent, no one knows where the violence will end (the domino argument again). The religious argument also applies here, adding the criticism that only God can create or take away life, and that, in His infinite wisdom, He will duly punish the killer in some way. Killing, in any case, is not the right of other humans under any circumstances. The religious argument is open to the same criticism as that presented in the discussion of suicide.

Arguments against killing in defense of the innocent and arguments that morally support killing in defense of the innocent all turn around the Value of Life principle. This principle advocates a reverence for all human life. For some, the Value of Life principle is absolute and killing is prohibited in all situations–even where innocent lives, or even one’s own, are threatened.

One can easily document countless cases where the Value of Life principle has been violated. There are people who show little or no regard for human life. Those who morally defend killing in circumstances where innocent lives are threatened or harmed also invoke the Value of Life principle in defending innocent lives but do so with the qualification that one should never kill except when defending innocent people. One’s self-defense is also included in this qualification.

Hearing a noise at the back of his house one afternoon, Ed picks up his loaded automatic pistol from a drawer in his desk and goes to investigate. He surprises an 18-year-old man in the act of going through his dresser drawers. The man has no weapons in his hands or in view. Ed asks what he is doing there, and the young man runs for the back door. Ed points the gun at his retreating back, fires three shots, and kills him. Is Ed morally justified in killing the young man?

Mary, 22, returns home fairly late one evening from a party. As she enters her bedroom, a man jumps at her from behind the door, pins her down with one arm, and covers her mouth with the other. He wrestles her to her bed, and as she attempts to scream, he hits her several times in the face and on other parts of her body. She somehow manages to push him off the bed and onto the floor, and while he is recovering his equilibrium, she gets a loaded pistol out of the bedside table drawer. As the man stands up again, ready to lunge at Mary, she fires several shots and kills him. Is Mary’s action justifiable?

The scene is a crowded outdoor shopping mall that has a clock tower at its center. Rifle shots ring out from the tower and several people, including children, drop to the ground—three are seriously injured and three are killed. Police try for several hours to get the sniper to throw down his weapon and come out, but he continues to fire his rifle into store windows, into a nearby parking lot, and into a nearby street. One of the officers, a sharpshooter with a high-powered rifle, manages to maneuver himself into a position where he can get a perfect shot, but only at the sniper’s head. He does so, killing the sniper instantly. Was the officer justified in killing the sniper?

1. 9.4 Review the arguments in favor of the morality of war

The Standard College Dictionary defines war as

“an armed conflict openly carried on between nations or states, or between different parties in the same state.”

The dictionary could have added, “and in which people, many of them completely innocent, are killed, usually violently.” Because of the wholesale killing that almost inevitably accompanies any type of war except a so-called cold one, war is a powerful threat to the Value of Life principle and should be avoided by every human effort possible. The arguments against war have increased during the twentieth and twenty-first centuries because of advanced military technology, especially the nuclear capability of various nations, which could lead to world destruction. The chances of a world war occurring seem to have diminished, and at least the larger nations have begun to see the futility of a nuclear war that would destroy everything and everybody. However, small wars, regional conflicts, and terrorism have increased in various parts of the world, and even though they do not involve nuclear weaponry, their destructiveness to life and the environment in each respective location is still unacceptable to peace-loving people and nations. Further, such small wars inevitably attract the involvement of the larger nations with nuclear capability, which makes any war a danger to world peace.

The main argument against the morality of war is that it is a direct and massive violation of the Value of Life principle. War doesn’t just involve the killing of one human being by another; rather, it involves a mass killing of up to millions, depending upon the scale of the war. Furthermore, especially because of modern military techniques, war necessitates the useless killing of a great number of innocent noncombatants, many of them children. Those who take an antiwar stance maintain that, in the long run, so little is gained by war and yet so much is lost in terms of human life and human possessions that it has to be considered an immoral act—in fact, the most immoral act human beings can perform.

This point of view was held widely during the Vietnam War era, when there was a tremendous rise in the number of conscientious objectors and outspoken pacifists. Pacifists have argued that war in all its aspects should be banned worldwide, and that violence and aggression should never be met with similar force but rather with nonviolence and nonaggression. They would argue, for example, that every peaceful effort must be exerted to avert war, but that even if a country is invaded, its citizens should try to pacify their violent invaders rather than resort to violence. This extreme form of the antiwar argument is held by a minority of the world’s population, even though it has grown in popularity because of the many destructive wars that have occurred since 1900. Many more people hold a moderate view: a general policy of nonaggression toward other people or countries.

Even though few people advocate war openly as a general solution to human problems, there are some traditional arguments in favor of war that should be examined:

1. War as the Best Controller of Overpopulation

2. War as the Mother of Invention

3. War as a Boon to Economic Gain and National Unity

4. War as a "Necessary Evil"

5. The Indefensibility of Nucluear War

The view that sees war as being the best controller of overpopulation is based upon the fact that the population of the world is increasing at a rate too rapid. Therefore, war, which effectively decreases the population, helps to solve this problem very efficiently. The argument is, of course, morally weak because alternate solutions are available, especially in our scientifically and technologically oriented society. In addition, one could argue effectively that the quality of population control achieved by war is very poor because it is the youth, the best hope of all societies, that generally suffer the greatest casualty rate. In any case, many countries have found alternate methods for reducing their populations without resorting to the destruction and decimation of war.

The argument has been advocated that war is the only way in which societies can develop and experiment with advanced technology. There is no doubt that many technological advances that were developed for military purposes have also been used in a peaceful way. Some of these advances are directly dependent upon war—for example, the development of advanced surgical techniques, prosthetic devices, and plastic surgery techniques that occurred during the Korean War. These certainly could have been developed without war, but perhaps it would have taken much longer to do so. Obviously, one has to consider the price that must be paid for such “invention.” Furthermore, it is certainly true that technological development can occur without war (e.g., by means of the space development program) even though peacetime development may be slower or more expensive.

Many argue that nothing unifies a people more than working together to achieve a national goal, such as winning a war. Furthermore, it is argued, such unification, which often involves the production of war machines and matériel, creates an upsurge in economic well-being and prosperity. This argument became particularly popular during and after World War II, especially in the United States. Nothing had ever unified the nation to the extent that the “war effort” did, and, despite wartime shortages, the nation achieved an economic prosperity that continued even after the war was over. The country mass-produced planes, tanks, weapons, and other matériel on a greater scale than ever before, and after the war, factories produced great numbers of peacetime goods—cars, homes, appliances—which the entire population desired after four years of deprivation. After two more wars, however, the divisive aspects of war became obvious, and people began to recognize that the cost of achieving economic prosperity through war is too high. As a matter of fact, though not the only factor in our economic problems, waging our current war on terror is certainly a contributing factor to such problems and therefore not a boon to our economy. Since World War II, countries have been able to unify and achieve economic well-being without wartime production, and this fact encourages most people to seek alternative means of attaining these national goals.

Probably the most morally significant argument for war is that although war generally is immoral, there is such a thing as a “morally just war” under certain conditions. One example of such an argument can be found in Roman Catholic teachings. Before discussing this argument, it should be noted that this type of thinking has been applied essentially to nonnuclear warfare; also, it would be incorrect to assume that this is the position presently held by the Roman Catholic Church. With these disclaimers in mind, the following conditions might be considered to describe a morally just war:

. . . that it shall be undertaken by the lawful authority; that it shall be undertaken for the vindication of an undoubted and proportionate right that has certainly been infringed; that it shall be a last resort, all peaceful means of settlement having been tried in vain; that the good to be achieved shall outweigh the evils that war will involve; that there shall be a reasonable hope of victory for justice (a war undertaken in face of certain failure is, however heroic, irrational, and therefore indefensible); there must be a right intention, that is, to right the wrong and not simply to maintain national prestige and influence or to enlarge territory (territory is not a just cause of war), nor may war be waged as part of a scheme for converting the heathen to Christianity; and the methods of warfare must be legitimate, i.e., in accordance with international agreements, with our nature as rational beings and with the moral teachings of Christianity.2

The Catholic Encyclopedia, from which this passage was taken, goes on to remark that there may be vagueness and uncertainty concerning any case of war being considered, and of course there is a great deal of vagueness and ambiguity in the passage itself. It does, however, provide some guidelines that have a moral basis:

• That the reason for war must be serious enough to outweigh its evils

• That it cannot be carried on for prestige, for territory, or to increase the influence of the nation waging it.

• The part about a war not being waged to convert heathens to Christianity should be expanded to include converting or punishing other religions, races, or nations for not believing in the aggressors’ policies or religions.

• That all peaceful means of settlement must have been exhausted.

• That a nation’s methods, once war is declared, must be legitimate.

Even such justifications, however, would seem to apply only to limited nonnuclear wars, because there is probably no political situation important enough to justify the possibility of setting off World War III and risking the total destruction of the human race and the world.

Even the arguments in support of a just war pale when one stops to consider the total devastation that could result from a nuclear war. This carries over to any defense of even limited wars because there is always a possibility that one of these could set off a large-scale nuclear holocaust. Given the tendency toward violence of the human species in general (Homo sapiens is the only species that destroys itself), it is probably too much to hope for that wars of all kinds can ever be totally eliminated, although every effort should be made to do so now and in the future. Barring the success of such an effort, however, any small wars should be contained and not allowed to mushroom into the use of nuclear weapons, especially by those countries that have large arsenals of such weapons. None of the arguments in support of war, including the just war argument, can morally justify a nuclear holocaust.

9.5: Terrorism

1. 9.5 Evaluate the history, purpose, arguments for and against, and the double standards of terrorism

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“Terrorism” in general terms, may be defined as warfare or violence waged deliberately against innocent parties, typically civilians and other non-combatants, in order to further or achieve a political, religious or ideological goal. The aim of violence, or threat of violence, is to cause fear and intimidation in order to break the will of a targeted group. It is designed to produce unsettling consequences for the purpose of eliminating, coercing and controlling that population.

Many people may think that terrorism is an activity that has been invented and practiced in the twentieth and twenty-first centuries, but the purposeful targeting of civilians is as old as warfare itself, and terrorism is a type of military warfare practiced by every nation including the United States. Terrorism can be traced back to Roman times; the Crusades in which Christians and Muslims employed it on each other; during the Indian and Civil Wars in the United States; the French Revolution; World Wars I and II; the Korean conflict; Vietnam; and the terrorist wars of Afghanistan and Iraq. Other modern-day terrorist attacks have occurred in Ireland and England, Israel and Palestine, the Oklahoma City Federal Building, the first bombing of the World Trade Center in New York, and, of course, the total destruction of the World Trade Center on September 11, 2001, in which over 3,000 people, mostly civilians, were killed and many injured.

The main purpose of terrorism is to protest violently against some serious differences of opinion, ideologies, world events, or culture. Terrorists seem to think that the only protest that has any significance is to destroy small or large segments of civilians with the idea that they will not support the policies or ideologies of the country where the attacks take place. However, though terrorism has been practiced throughout history, it has continually been a failure because the civilians attacked in such a fashion have turned against and rejected their attackers. For example, in the case of the September 11, 2001, attack, it, if anything, has hardened the resolve of the U.S. government and its civilians against the terrorists.3 It is important to note that terrorists are indeed soldiers who wage war, albeit a different kind of war, who have a financial base, excellent communications and intelligence, and, in the case of the September 11 attacks, several sovereign countries to sponsor and support them in every way they need. One has to recognize, no matter how terrible the attack on September 11 was, the ingenuity of the attackers. They needed no missiles. They commandeered civilian planes filled with fuel and used them as missiles requiring the terrorist crews to act as suicidal soldiers. Their intelligence was so far superior to ours that no one even suspected the attacks were to take place until they actually occurred.

Journal: Terrorism

What is terrorism, and how does it differ from other kinds of war?

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Despite the fact that nonviolent protest was put forth by Mahatma Gandhi in India and Martin Luther King, Jr., in America, many organizations formed out of cultures and nations of angry people, many of these in the so-called Third World countries, have come to feel that nonviolent protests are ignored and ineffective at best and only get them killed by their oppressors at worst; therefore, violent actions, such as bombing, the taking of hostages, and guerilla attacks, are seen as being the only surefire ways of getting the powers-that-be to recognize them.

Because these organizations feel that they will continue to be ignored, they have resorted to violence in order to bring attention to their causes. It’s true that innocent people will die, but terrorists reason that no one not on the side of their cause is innocent, so they don’t care. They feel they are in a war for their rights, freedom, culture, religion, or territory, and war means that people will die.

Journal: Moral Justification of Terrorism

Is terrorism morally justified? Defend your position.

The main argument against terrorism is that excessive violence, especially where it involves the lives of innocent people, cannot be condoned. Terrorism, as its advocates state, is war, but undeclared war and certainly not war in defense of the innocent. As stated earlier, one can argue for just wars, dutifully declared and fought only for the defense of the innocent by the military of both sides. But the wide-ranging approach to violence that terrorism uses, in which innocent bystanders are murdered, is morally unjustifiable. People who are against terrorism argue that wrongs must be righted by reason, by negotiation, and in other peaceful ways. This may take longer, but it is safer for everyone concerned. Furthermore, terrorism usually does not aid the causes of its advocates because it prompts greater terrorism from the other side. Also, it tends to turn against its adherents all those who believe terrorism to be immoral. Therefore, according to those opposed to terrorism, it can never be justified.

Terrorism is a type of violence and, since it is violence that intentionally targets the innocent, it is generally considered to be wrong and is universally condemned. As seen earlier, consequentialist arguments can be made in support of terrorism. But, because such arguments are essentially attempts to justify violence against the innocent, they are not rationally persuasive. In contrast, nonconsequentialist theories, such as Kant’s, would hold that terrorism denies the intrinsic worth of persons in that it treats persons solely as means and not as ends.

Igor Primoratz (1945– ) notes the following curious fact about the concept of terrorism: “Nobody applies the word to oneself and one’s own actions, nor to those one has sympathy with or whose activities one supports. As the hackneyed cliché has it, one person’s terrorist is another person’s freedom fighter.”4 In other words, self-interest and partiality foster a double standard relative to the application of the term in the public debate about terrorism by creating an “us versus them” framework for discourse.

The second double standard involves nonstate actors, for example, “insurgents,” versus actors engaged in similar violence sanctioned by the political state.

The term terrorism, almost as a matter of definition, is applied to insurgents and not to agents of the state—especially when it is one’s own political state that is in question.

There are a number of arguments that question the morality of war. Since war is a direct and massive violation of the Value of Life principle, especially in those instances when nuclear weapons are deployed, many take the view that no ethical position can justify war. War causes a great deal of useless killing and suffering, especially of innocent noncombatants. Aggression and violence must be dealt with through peaceful means. One must, on the view opposing war, adopt pacifism or some other nonviolent approach such as a commitment to nonaggression toward other people or nations.

On the opposite side of the issue concerning whether war is justifiable is the theory of a “morally just war.” Although war is generally immoral some conflicts may be morally justifiable. This theory originates in the teachings of the Roman Catholic Church and, in a manner of speaking, sees war as a “necessary evil.” The justification for war is presented as an extended self-defense argument and/or killing to prevent the death of innocents. Massive nuclear war however, even on a just war theory, is indefensible.

A small nation located on a seacoast has both the commercial ports and the natural resources that a larger neighboring inland nation needs. The larger nation negotiates for use of the ports and purchase of the resources, and an agreement is reached between the two nations that lasts for several years. Eventually, however, a new government that has come to power in the larger nation decides that it should not have to pay for natural resources so close to its own borders and that it should have complete control of the seaports it now uses. After a breakdown of new negotiations, the larger nation invades its smaller neighbor, and the smaller nation aggressively defends itself. Is the larger nation justified in starting a war, and is the smaller nation justified in defending itself?

To what extent does the U.S. invasion of Iraq fit with the Catholic description of a just war? To what extent do you think this invasion was justified at all under any circumstances. To what extent do you think this is a war of terrorism on both sides? Be specific.

A small Asian country that is rich in natural resources has suffered an ideological split. One half of the populace advocates communism as a form of government, whereas the other half advocates a democratic form. Two larger powers outside the country develop an interest in the struggle: Country A supports the communist faction, whereas country B supports the democratic faction. Both of the larger countries have vested interests in the Asian country in the form of mines, factories, land, and financial investments. When the two factions in the small country declare war on each other over their differing ideologies in a struggle for control of the entire land, the two larger countries begin to support their respective sides by sending money, arms, supplies, and military advisers. As the democratic faction weakens and begins to lose the war, country B steps up its support by sending in elements of its own army, navy, and air force, committing itself to helping the democratic side by any means other than nuclear warfare. To what extent are the two factions in the Asian country justified in entering into warfare against each other, and to what extent are the larger powers justified in supporting their respective sides.

It is important therefore, as good critical thinkers and individuals trained in ethical reasoning, to be alert to the nuances of political rhetoric and to clarify our meaning of the word terrorism in order to develop well-reasoned arguments about whether it is morally acceptable. Furthermore, one would do well to understand the social, economic, political, and cultural conditions that give rise to and support terrorism—not to rationalize or legitimize terrorist acts—but to eliminate, so far as possible, such conditions. Although certain conditions may help explain terrorism, such conditions cannot justify it.

1. 9.6 Evaluate the pros and cons of capital punishment

As most dictionaries define it, capital punishment means “the infliction of death for certain crimes.” These crimes often are called “capital crimes,” and depending upon the society in question, they have varied from stealing to murder. For the most part, especially in the United States, capital punishment is usually applied for murder—especially premeditated murder—or kidnapping with intent to do bodily harm or kill, and sometimes for instances of treason that endanger the lives of those living in a country.

Punishment should be given only when it is deserved and only to the extent it is deserved. It should have no other goal than punishing people who deserve the punishment because of some immoral act that they have committed, and the punishment should fit the crime.

Punishment always should have as its aim the good of society. If punishment will bring about good consequences for people, then it should be given; if it won’t, then it shouldn’t. It always should be given in order that some good can be done—for example, to deter future crime, to protect society, or to rehabilitate a criminal.

Justice is served only if the victims of a crime or offense are provided with restitution or compensation for the harm done to them.

Capital punishment could conceivably be acceptable in all of the preceding theories, at least in some cases but not in others. For example, it certainly would fit the retributive theory, but only if the person to be punished truly deserved the punishment. Utilitarians also might approve of such punishment, but only if the greatest number of good consequences were to come about because of it. If the only compensation for murder, for example, was considered by restitutionists to be the execution of the murderer so as to satisfy and compensate the victim, then capital punishment might be deemed acceptable by them too. However, most restitutionists probably would consider that such punishment actually would thwart proper compensation of the victim because the criminal or offender no longer would be alive to work for the victim’s benefit, for example.

Many argue against capital punishment on the grounds that it is a direct violation of the Value of Life principle. They maintain that capital punishment amounts to murder—social murder—directed by society against one of its members. The argument further says that if taking human life is wrong in other instances, then it is also wrong in this instance. True, the argument continues, capital punishment can function as a form of societal retribution or revenge, but in a civilized society, this should not be deemed a sufficient motive for taking a human life.

Because killing a criminal will not bring back his or her victims, or in any way compensate the survivors of the victims, there is really no purpose in taking the criminal’s life other than to satisfy the society’s need for revenge or the victims’ need for retribution. This, according to the opponents of capital punishment, is not a civilized emotion. They feel that capital punishment encourages violence, acts of revenge or retribution, and murder in society at large because it leads to the rationale that if society can kill its members, then individuals also can take revenge into their own hands.

One of the most common arguments for capital punishment, as we shall see, is that it deters crimes throughout the society; its opponents, however, argue that there is no conclusive evidence to support this claim. They point to history in support of their argument, stating that when capital punishment was used against thieves in England, pickpockets were operating throughout the crowds of watchers who gathered to see a thief hanged. They also question why, if this punishment works so well as a deterrent, executions by hangings, by firing squads, in gas chambers, and by lethal injection are not shown on television or performed in the streets, rather than being carried out in the relative privacy of our prisons. They argue further that killings occur even in prison, right outside the execution chamber. Therefore, they state, capital punishment does not serve as an effective deterrent.

Sometimes people accused of capital crimes are convicted on mainly circumstantial evidence, and therefore it is quite possible to execute an innocent person. If even one innocent person is executed, this argument continues, then capital punishment is a moral wrong. Furthermore, because rich people who are charged with capital crimes can afford better attorneys, the people most often convicted of capital crimes are poor people, often members of minority races—for example, African Americans, Hispanics, or Native Americans. This means that punishment by killing may be applied unequally to people who commit similar crimes. This is even a more prevalent problem with the introduction of DNA (deoxyribonucleic acid) testing or fingerprinting as it is often known. This testing, developed in the twentieth century, has enabled forensic specialists to acquire a specimen from a person (e.g., saliva, blood, and semen) and match it with materials found at the scene of a crime or on a victim’s body or clothes. This testing not only has helped to convict guilty people of crimes but also has helped find allegedly guilty people, who are often waiting on death row, innocent of crimes. In addition, other circumstances, such as the unreliability of so-called jailhouse informants, unqualified defense attorneys, and racism as described earlier, have resulted in the reversal of many capital crimes. The governor of Illinois recently halted executions in his state and declared a moratorium for all of the earlier-mentioned reasons, saying, “Until I can be sure that everyone sentenced to death in Illinois is truly guilty—until I can be sure with moral certainty that no innocent man or woman is facing a lethal injection—no one will meet that fate.”5 When his term was up, he pardoned all the prisoners on death row and gave them life imprisonment without parole.

The denial of the chance for rehabilitation argument states that nothing is accomplished by capital punishment other than the compounding of the badness already caused by the original crime: Instead of one human life being taken, capital punishment causes two to be taken. Wouldn’t it be more valuable, opponents of capital punishment ask, for society to eliminate killing by reforming killers through education and other methods of rehabilitation? They argue further that most killers have been shaped by a corrupt society or a poor early environment (child-abusing parents, for example), and that if we could only reeducate them they could become useful members of society.

People who argue for capital punishment strongly disagree with those who state that it is not an effective deterrent. They argue, with irrefutable logic, that capital punishment deters the killer from killing again by terminating his life. They admit that the evidence for general deterrence may not be conclusive, but they strongly believe that many people are prevented from killing, or at least think twice about it, when they know that they may have to face the death penalty for their crime. According to capital punishment’s supporters, the reason it isn’t always an effective deterrent is that it isn’t used enough. Many of its supporters are also in favor of making everyone watch the execution of legally convicted killers so that deterrence would be more effectively reinforced. Let's explore some more arguments for the morality of capital punishment.

There is no proof that murderers can be successfully rehabilitated, and sentences of “life imprisonment” seldom really mean life because many murderers are released from prison after seven or ten years. Some have been released and have killed again. With these facts in mind, supporters of capital punishment think that it is much too costly for innocent taxpayers to support killers in prison for long sentences or for life. Why, they ask, should innocent people pay for the continued support of criminals who have proved themselves unfit to live in society? The crimes they have committed are so terrible that there is no reason they should be allowed to live while innocent people pay for their upkeep.

One criticism of this argument is that it costs more to give a criminal capital punishment than it does to give him or her life imprisonment without parole, given all of the appeals and court actions often gone through in the case of a criminal who has been sentenced to death. The main criticism of this argument, however, holds that when human life, even reprehensible human life, is at stake, a civilized society and humanity should not be concerned with monetary costs. Even though it costs a great deal of money to keep criminals in prison, and even more of it when rehabilitation programs are implemented, critics of the economic argument believe that it is more moral to try to make a human life useful than to terminate it even though it is cheaper to execute prisoners than to rehabilitate them. Isn’t it extremely dehumanizing, they ask, to argue that the maintenance and possible rehabilitation of human life is less important than mere financial cost? This issue will surface again when we discuss the cost of maintaining the lives of innocent people who are in terminal stages of illness.

By having the option of applying the death penalty, some argue, we give strong sanction to the entire criminal law enforcement system—we “put teeth” into that system. For example, suppose a criminal is convicted of armed robbery, serves a term in prison, and then is released. The very existence of capital punishment reminds this person that if he or she returns to armed robbery and later kills someone while committing this second crime, the death penalty may be applied.

The sanction argument suggests that criminals will be deterred from escalating the nature of their crimes because of the death penalty threat, and that this in turn gives the entire criminal justice system strength. The threat of the death penalty may even encourage criminals to leave the “armed” out of armed robbery, thus minimizing the chance that an innocent person will be killed.

The main criticism of this argument is that there are other, more humane ways of giving a system of law enforcement sanction. Highly effective legal systems have existed without capital punishment (England’s, for example), and there is no conclusive evidence that the existence of capital punishment has any deterrent effect on the thieves, embezzlers, rapists, and other criminals to whom the death penalty cannot usually be applied. Effective prosecution and just punishment would seem to be as, or more, effective in preventing crime as is maintaining the death penalty as a part of the system.

Journal: Alternative for Capital Punishment

What, in your opinion, would constitute a just alternative punishment to capital punishment and why?

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Another argument for capital punishment, in answer to the violation of the value of life argument, is that killers, having violated both morality and the law, have forfeited their right to be treated ethically. Just as you would kill a rabid dog or a wild animal who threatened the lives of innocent members of society, so too you should punish these killers. Some argue further that capital punishment is merely another form of self-defense, one that applies to the entire society. Just as individual people have the right to protect themselves against killers who threaten their lives, so society has the right to protect itself against anyone who has killed once by ensuring that he or she does not kill again. Prison, they argue, is not an adequate means of ensuring this, because killers can be paroled or can escape as some did in a Texas prison recently and others were murdered; therefore, the argument continues, capital punishment is moral.

It certainly would seem to be the case that people who have killed should forfeit some of their rights. The question is whether this forfeiture should include their very lives. Certain killers have proved themselves to be so dangerous as to forfeit their right to live freely among other innocent people, but does this mean that they must be killed? Furthermore, there are some cases in which killers have been paroled and have lived normal lives from that time on, even contributing something positive to society in the process. There are even cases in which criminals contribute something good to society while in prison.

A final, classic argument for capital punishment is based upon the idea of revenge, or the “eye-for-an-eye” concept of justice. This argument says that if people kill, they must forfeit their lives in order to “balance the scales.” This is an ancient concept, dating back to at least Old Testament times, and it often has been the basis for long-lasting feuds and vendettas between families, gangs, tribes, or other groups. For example, if the son of a chief of tribe A is killed by a member of tribe B, then the son of the chief of tribe B must be killed, and so on.

Journal: Self-Defense

What are your views on permits that allow fellow citizens carrying firearms for self-defense? Give reasons for your stance.

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Capital punishment is imposed in response to “capital crimes” such as murder, kidnapping, rape and torture. The penalty in such cases is usually death, and this punishment represents society’s ultimate rejection of the person who commits such offenses. In the judgment of peers, that person is no longer fit to walk among others as a member of the human moral community.

Arguments for and against the morality of capital punishment take into account the nature of the offense, the motive, and the circumstances under which the crime took place. In addition, the fairness of the justice system and the means used to execute the condemned are considered. The arguments also consider factors such as the outcomes of capital punishment and possible alternate forms of punishment, such as life in prison or rehabilitation.

1. 10.1 Evaluate euthanasia with respect to the application of human rights

The word euthanasia comes from Greek and originally meant “a good death.” However, it has also been interpreted, especially in the twentieth century, to mean “mercy killing,” legally a form of murder in most countries of the world. Dr. Richard Lamerton, former director of St. Joseph’s Hospice Home Care Service in London, has stated that in using the term euthanasia to stand for both mercy killing and allowing someone to die, we seriously blur a very necessary and important distinction between an act of murder and what is merely good medical practice (allowing people to die of natural causes, without using any extraordinary or heroic measures to keep them alive).

Dr. Lamerton states further that even though euthanasia once meant “a good death,” it no longer has that meaning but rather means mercy killing or murder.1 Therefore, because of this confusion and the ambiguity of the meaning of euthanasia, this module will not use this term but will substitute three other phrases: “allowing someone to die,” “mercy death,” and “mercy killing.” Each of these phrases has a different meaning, and they must be clearly defined and distinguished before one can deal with the important moral issues surrounding them.

The phrase “allowing someone to die” implies an essential recognition that there is some point in any terminal illness when further curative treatment has no purpose and that a patient in this situation should be allowed to die a natural death in comfort, peace, and dignity. In no way does this involve an active termination of someone’s life. Rather, it involves a refusal to start curative treatment when no cure is possible and the willingness to halt curative treatment when it can no longer help a dying patient.

What it means, in short, is allowing a terminally ill patient to die his or her own natural death without interference or intrusion from medical science and technology. It does not mean that there is nothing that can be done for the patient or that the patient should be abandoned to die in pain and misery. It does mean, however, that medical science will not initiate heroic efforts to save a dying patient and that it will stop any such efforts that have already been started when it becomes clear that they cannot serve any useful purpose for the patient and his or her family.

The phrase “mercy death” means taking a direct action to terminate a patient’s life because the patient has requested it; in short, mercy death is really an assisted suicide. Chronically or terminally ill patients often are unable to commit suicide and therefore ask someone (often a physician) to “put them out of their misery.” These patients not only give their permission to end their lives but also, in most cases, request or even demand that their lives be terminated.

The phrase “mercy killing” refers to someone’s taking a direct action to terminate a patient’s life without the patient’s permission. The decision to take such an action is often made on the assumption that the patient’s life is no longer “meaningful” or that if the patient were able to say so, he or she would express a desire to die. The important distinction between mercy killing and mercy death is that mercy killing is involuntary, or does not involve the patient’s permission or request, whereas mercy death is voluntary and done with the permission of the patient and usually at his or her request.

Journal: Difference between Mercy Killing and Mercy Death

Discuss if mercy death is significantly different from mercy killing. Or, in certain situations is mercy killing morally preferable? Give reasons for your answer.

1. 10.2 Examine the arguments for and against the morality of mercy death and mercy killing in two real-life medical conditions

At present, 39 states specifically prohibit mercy death (or assisted suicide), and almost all of the remainder, and most countries of the world, make it illegal under general homicide statutes. Mercy killing is presently outlawed in all of the U.S. states and most of the countries of the world. However, two legal actions by two U.S. courts of appeal, one in New York and the other in the state of Washington, have muddied the legal questions surrounding assisted suicide, and this has led to further appeals and upcoming decisions by the U.S. Supreme Court.

In April 1996, the U.S. Circuit Court of Appeals in Manhattan ruled that New York’s manslaughter statute could not be used to prosecute doctors who prescribe lethal drugs to terminally ill patients who ask for them and then use them to commit suicide. The judges wrote, “What interest can the state possibly have in requiring the prolongation of a life that is all but ended? . . . And what business is it of the state . . . to interfere with a mentally competent patient’s right to define [his] own concept of existence, of meaning, of the universe, and of the mystery of human life?”2

On March 6, 1996, in San Francisco, California, the Ninth Circuit Court of Appeals “declared physician assisted suicide to be a fundamental constitutional right protected by the 14th Amendment’s guarantee of ‘liberty.’ ” “The decision how and when to die is one of the most intimate and personal choices a person may make in a lifetime, a choice central to personal dignity and autonomy.”3 Of course, legality is not our main concern in dealing with these problems; we are concerned with whether any of these three options is moral and, if so, under what conditions. Therefore, we will now discuss each of these options in more depth, examining the arguments for and against each of them and exploring the full implications of each. Before doing this, however, it is important that we define one more phrase.

The advanced medical technology and sophisticated procedures available in the twenty-first century have created new moral dilemmas, one of which involves irreversible brain damage, popularly known as brain death. Before medical technology became so sophisticated, when patients’ hearts or lungs failed, soon their brains also failed, and when their brains failed, heart or lung failure soon followed. In our time, however, we have discovered ways (e.g., by using respirators and heart machines) to bypass the brain, thus avoiding heart or lung failure.

If a patient is brought in with a head injury from a motorcycle accident, for example, the emergency crew may get the person’s heart and lungs restarted and manage to stabilize these two organ systems. Later, doctors may discover that the head injury was so serious that the patient’s brain has been irreversibly damaged; in other words, the brain is permanently dead, not just temporarily injured or even partly injured. Without brain activity, the patient is reduced to a body with a beating heart and breathing lungs. After a number of such instances had occurred, the medical community began to recognize the possibility that a person could be pronounced dead in a medical sense if his brain were irreversibly damaged—even if the patient’s body could be considered to be alive in all other respects.

In 1968 an ad hoc committee was formed at Harvard Medical School to decide upon criteria for determining brain death.

The ad hoc committee’s final report cited the following four criteria:

1. Un-receptivity and unresponsiveness

2. No spontaneous movements or breathing

3. No reflexes

4. A flat electroencephalogram (EEG)4

What this means, then, is that people can be declared medically dead even though their hearts and lungs are still functioning. Many people have confused the problem of brain death with allowing someone to die and mercy killing; they maintain that if a doctor or nurse disconnects the respirator or heart machine or feeding tube that is aiding a patient who has suffered brain death, then this person is guilty of allowing the patient to die or of mercy killing. This, however, is not the case; if patients are declared dead in an official medical sense, then any equipment can be disconnected and any procedure can be stopped without there being any implication of wrongdoing. After all, how can a patient who is already medically dead be allowed to die or undergo mercy killing?

The confusion that arises in such cases comes chiefly from our distaste for disconnecting patients with breathing lungs and beating hearts from machines that would keep these organs functioning. Suffice it to say that brain death has nothing to do with allowing someone to die, mercy death, or mercy killing. Some states (California, for example) have even included brain death in their legal definition of death. There is still a problem, however, in dealing with people who have not suffered brain death but who are severely brain damaged. Some injuries do not kill the brain; rather, they leave it so badly damaged that when and if patients awake from a coma, their lives are likely to be radically altered. Furthermore, such patients may remain in a coma for an indefinite period yet not meet the criteria cited earlier for brain death. The issues of allowing someone to die and mercy killing may definitely arise in relation to this last type of case, but they should not be considered as being in any way related to a clear-cut case of total brain death.

Brain death should be carefully distinguished from persistent vegetative state (PVS). PVS results from damage to the cerebral cortex, or neocortex, which controls the cognitive functions. For this reason, it might be called cortical or cerebral death. The body, however, is not dead because the functions of the brain stem continue in whole or in part. In PVS there may still be, and usually is, spontaneous breathing and heartbeat. Persons in this state often are awake, but they are not aware of what is going on around them. There is no conscious interaction with the environment and no awareness of self or the environment. A person in this state lacks and will permanently lack even that minimal level of functioning that makes life human. They are, in short, incapable of any human interaction. The very famous cases of Karen Ann Quinlan, Nancy Cruzan, and Terri Schiavo are examples of PVS.

10.3: Allowing Someone to Die

1. 10.3 Examine the arguments for and against allowing someone to die

LISTEN TO THE CHAPTER AUDIO:

As we have already defined it, “allowing someone to die” means allowing a terminally ill patient to die a natural death without any interference on the part of medical science. The problems surrounding this issue, along with those surrounding mercy death and mercy killing, have arisen much more frequently in the twentieth and twenty-first centuries than at any other period. The reason for this is that advancing medical technology has made it possible for more people to live longer than ever before. As recently as a few years ago, when the heart or lungs failed, a person was sure to die within a short period of time. Nowadays, however, a person can be kept alive almost indefinitely by respirators, heart machines, feeding tubes, pacemakers, miracle drugs, organ transplants, kidney dialysis machines, and so on.

With these advances, which certainly are a blessing for many, additional problems as to the quality of the lives we are extending have arisen. For example, people with kidney failure, who would have died prior to 1960, now can be saved. Many of them adjust beautifully to their situations, but others feel that if the only way they can remain alive is to be hooked up to a kidney machine for the rest of their lives, they would rather be dead.

Medical science is also working very hard on a cure for cancer, frequently a long, drawn-out disease that causes patients to slowly deteriorate and eventually lose their sense of dignity. It is ironic that as these patients’ lives are extended by means of advanced medical technology, so too are their pain, suffering, and misery—sometimes in the hope that a cure will be found and sometimes simply because the doctors don’t want to give up on any of their patients.

Similarly, because most people live longer than ever before, they sometimes become senile and infirm. We tend to relegate such people to hospitals or nursing homes, where, in many instances, they live out a tiresome, dreary, and despairing existence, often in pain and suffering. Therefore, literally thousands upon thousands of people, of various ages and in various stages of dying, face what many would describe as lives of low quality. If we add to this the extremely well-documented fact that people of the Western world, and especially those living in the United States, generally do not have the ability to face aging or death well, we have a serious problem that we must try to solve in the most ethical way possible.

Very few of us want to see other human beings suffer or live lives from which they are begging to be released. For this reason, it seems to many people that what we need to do is to accept as moral, and then legalize, some methods of allowing patients to die, mercy death, or mercy killing, preferably in some painless form to be administered by doctors, or by patients with the help of doctors, so that “miserable, meaningless” lives can be ended with dignity.

It is difficult to question the validity of the motives behind the desire to end the misery and pain of others. Furthermore, one can justify these motives within the five basic principles:

• Because it is possible to revere life and yet accept death.

• Because it is possible to bring happiness and eliminate pain, both for patients and their families, creating harmony where there was disharmony, and ending lives lacking excellence, whereas enhancing other lives with excellence.

• Because it is possible to be just and fair, not only to patients and their families but also to the rest of society on whom sick and dying patients often are a burden.

• Because it is possible to grant individual freedom to terminally ill patients to die and be allowed to die, as well as the freedom to decide how and when to die, it seems obvious to many that allowing someone to die, mercy death, and mercy killing can be morally justified.

Let us now examine the arguments for and against allowing someone to die.

Journal: Moral Justifications for Mercy Killing

Is mercy killing morally justified in all or only under circumstances? Give reasons for your answer.

It is a common assumption that human life always is to be protected and preserved, regardless of its quality, by every means we have at our disposal. This assumption has given rise to a number of arguments against allowing someone to die.

Some people argue that not using or discontinuing any means that might keep dying people alive even a little longer is tantamount to refusing them proper medical care. They feel that if health care professionals (doctors, nurses, etc.) refuse to apply curative treatments, they are abandoning patients and their families to suffering and misery.

It certainly is true that health care professionals could conceivably abandon patients for whom “nothing more can be done.” This probably has happened in the past, and indeed, it may be happening in some cases today. However, there is no reason why this need occur. Abandonment arises from an overemphasis on that aspect of medicine involving curing and healing patients and a lack of emphasis on the aspect involving comforting and caring for them, which is every bit as important. Alternately, the hospice approach to care for the dying makes this distinction clear and completely eliminates the abandonment problem.

Many doctors, as well as others not in the medical profession, argue that by virtue of the nature of medicine, one can never opt for death; one must always choose life. After all, the reason medicine exists is to save lives, not end them, and the minute we start to make those choices that lead to death rather than life the very basis for medicine is nullified. This results not only in the discouragement of doctors but also in an elimination of patients’ trust in doctors, often a necessary adjunct to the healing process.

One of the arguments brought against this view is that there is a great deal of difference between “choosing” death and “accepting” death when it is inevitable. A second argument is that many dying patients do not agree that “everything must be done” to save them, and they strongly object to doctors overriding their decisions about their own bodies and lives. The doctors, of course, argue that they know best and that they must be the ones to make all the decisions about a patient’s treatment. The patients, however, feel that they ought to have the right to refuse treatment as well as to accept it.

The final argument against allowing someone to die states that only God can create and take away life, and that mere human beings should not be permitted to allow people to die, much less take their lives in an active way. According to this argument, we must use all of our abilities and every method at our command to save, protect, preserve, and extend human life until the Creator has decided that it is time for a terminally ill patient to die.

In this situation, however, it becomes a two-edged sword; that is, the concept of God’s divine plan can be used to argue for or against allowing someone to die. The argument against such an action has already been stated. The argument for allowing someone to die begins with the assumption that God meant for all humans to die and that the development of medicine has interfered to a great extent with God’s original plan. That is, God did not mean for human beings to live forever, and when medicine prolongs life it interferes with His plan.

The problem with both sides of the argument, of course, is that it is not at all clear what God’s specific plan is in relation to allowing someone to die. Furthermore, deciding when to start or stop medical treatment is not a decision made by God. Rather, people—doctors or patients—make these decisions. People who believe in God can certainly say that God has given them a choice with regard to this issue, but they cannot abdicate their responsibility by saying that God is doing the deciding.

Most arguments for allowing someone to die are based upon the principle of individual freedom—specifically, upon the rights of individual dying patients to make decisions about their own bodies and lives.

In much the same way as it applied to the arguments for suicide, the idea that people have the right to decide about their own lives or deaths applies to allowing someone to die, and also to requesting mercy death. This right also includes the right of rational patients to refuse treatment when they so desire.

There is, of course, a difference between taking a direct action to end one’s own life and merely allowing a disease, deemed to be a part of the natural process, to follow its course without interference. And the process of allowing someone to die does not involve suicide or killing of any kind. In “A Patient’s Bill of Rights,” which was drawn up by the American Hospital Association, patients are accorded, among other rights, “the right to refuse treatment to the extent permitted by law and to be informed of the medical consequences” of their actions.5

No one has absolute rights over his or her own life and death. This belief is reflected in the phrase “to the extent permitted by law” in the Patient’s Bill of Rights—a phrase that obviously limits people’s rights over their own bodies and lives. The general view, however, is that mentally competent people (and mental incompetence is very difficult to prove legally) should have the right to refuse treatment in most cases. This point of view is most strongly held when the treatment is as bad if not worse than the disease—which often is the case. For example, many treatments for cancer result in constant nausea, loss of hair, destruction of healthy as well as diseased tissue, and disfigurement. The individual rights argument offers patients the option of simply letting the disease follow its course rather than being subjected to the sometimes horrible effects of the various treatments offered to them.

Another argument for allowing someone to die is that it shortens the time during which a dying patient must endure suffering, pain, and misery. Often our highly advanced medical technology is used to prolong the death—rather than the life—of patients so that they can “enjoy” a few more hours, days, weeks, or months of pain. For example, if a cancer patient has about eight hours left to live and goes into kidney failure, then prolonging his or her dying by starting dialysis would be considered to be an extension of pain and suffering but not of meaningful life. It is much more humane, according to this argument, to alleviate the person’s misery by allowing him or her to die of uremic poisoning.

The main criticism of this argument attacks its very basis. Yes, critics may say, allowing someone to die will shorten a patient’s suffering, but it will also shorten his or her life, and shortening a person’s life is immoral. Furthermore, if the policy of allowing people to die were to become general practice, it might be applied to those whose pain could be controlled and who therefore might have led relatively happy, significant lives.

Another argument for allowing someone to die is that people have the right to die with dignity rather than waste away and suffer until there is little left of their original character. This argument is especially forceful in relation to long-term debilitating and degenerative diseases, such as cancer. The idea at the basis of this argument is that if nothing is done in the way of extensive medical treatment, then patients will die without enduring the indignities of being operated on, fed intravenously, or hooked up to machines. The argument states further that “dignity” is also achieved when patients are given choices concerning the kind of living and dying they will do.

The main criticism of this argument is that the phrase “death with dignity” can mask everything from medical abandonment to mercy death and mercy killing and, furthermore, that no dignity will be lost as the result of a heroic attempt to save people’s lives or to keep them alive as long as we possibly can.

Journal: Allowing Someone to Die on Basis of Moral Ethics

Analyze one of the issues dealing with allowing someone to die utilizing one of the major ethical theories. Evaluate the same issue according to a different moral theory. Did you reach the same conclusions?
Explain your answer.

Submit

There is an important distinction to be made when one is dealing with the problem of allowing someone to die, and it has to do with exactly what means doctors are justified in using to keep people alive. In a speech to anesthesiologists in 1957, Pope Pius XII described two types of means that may be applied in medicine to keep people alive, calling them “ordinary means” and “extraordinary means.” What he said, essentially, was that doctors are justified in using extraordinary means up to a point to keep people from dying, but that they are not obligated to use such means indefinitely. In hopeless cases, doctors are obligated only to use ordinary means, and they are given the option either to not start or to discontinue extraordinary means. The distinction inherent in these two phrases sounds promising, but unfortunately the terms often are quite difficult to define clearly. Let us examine more closely what Pius XII said and then see whether some clear distinctions can be made.

The pope defined extraordinary means as those that

“according to circumstances of persons, places, times, and cultures . . . involve a grave burden for oneself or another.”6

This is, of course, a rather vague definition, and because persons, places, times, and cultures vary a great deal, it is not easy to come up with a stock list of extraordinary means. The situation described earlier in this chapter of the completely metastasized cancer patient who went into kidney failure is a clear example of this. To apply dialysis in this case would be to employ extraordinary means to save this person’s life; on the other hand, to merely try to control pain and keep the patient comfortable would be to use ordinary means of treatment.

If a patient is in a coma as a result of a drug overdose, then perhaps using dialysis to purify his or her blood of the toxic substances would be more justified than it would be in the cancer case; nonetheless, one still might question whether kidney dialysis is not always to some extent extraordinary treatment. Still, there certainly is a difference between keeping a patient comfortable and well cared for and doing radical surgery or giving radiation therapy.

The phrase “ordinary means” is almost as hard to define as “extraordinary means,” again because of the wide variation in people, places, times, and cultures. We could make the distinction that once a patient’s disease has been diagnosed as terminal, then continuing with chemical and radiation therapy or doing radical surgery would be extraordinary means, whereas controlling pain and other symptoms would be ordinary. This example may offer a fairly clear distinction, but there are other cases that are far more problematic.

For example, when kidney dialysis machines were in scarce supply and when individual patients had to pay the expenses (about $30,000 per year at that time), the use of these machines would have been considered extraordinary even though they were necessary to keep people with kidney failure alive. Now, however, when there seem to be enough machines to dialyze all kidney failure patients and when about 85 percent of the cost is paid by the government, perhaps dialysis can be considered to be ordinary means. It is interesting, however, that this treatment has placed heavy enough financial, physical, and emotional burdens on a few kidney failure patients and their families that they really did seem to consider it extraordinary means to the extent that they discontinued it.

At any rate, whenever there is discussion as to the problems inherent in allowing someone to die, the distinction between these two types of means usually comes into play. Generally speaking, when one is considering allowing someone to die, the discussion is about not starting, or about discontinuing, extraordinary means (e.g., respirators, heart machines, radical surgery, and organ transplants). However, one also may be considering the not starting or discontinuing of ordinary means. For example, feeding patients is often considered to be ordinary means in most circumstances, but doctors can switch from high-nutrient feedings to minimal or no nutrient feedings that will not effectively prolong patients’ lives.

There was a case several years ago concerning a man in his eighties who told his family he didn’t want to live any longer. From that moment on he refused to eat anything, and he begged his two grandsons not to let anyone force-feed him in any way. They honored his request, and he was allowed to die the death he had chosen.

Similarly, a woman in the advanced stages of metastasized cancer had a large growth blocking the tube that passes food to the stomach. The doctor and her family did not use any extraordinary means, such as surgery, to remove the growth, nor did they try to force-feed her in any way. They merely kept her comfortable; letting her taste homemade food even though she couldn’t swallow it and letting her suck on ice chips to quench her thirst. Literally, they were allowing her to die of starvation. As these two cases illustrate, there are times when even the refusal to use ordinary means may also be involved in allowing someone to die.

Perhaps, given the confusion that abounds in reference to the terms ordinary and extraordinary, more suitable terms would be appropriate and inappropriate care. Although initially these terms may seem as vague as the others, they allow doctors, nurses, patients, families, and other caregivers to decide on how to treat a patient based upon what is appropriate to the particular patient. Rather than trying to decide what would constitute ordinary or extraordinary means, caregivers and patients could then base their decisions on what seemed to suit the particular situation of the patient.

Under this criterion, all means of care would have to be decided upon by the patient, family, doctors, and nurses as to whether or not it would be appropriate for a particular patient in a particular situation. This means that all forms of care are subject to the determination of being appropriate for a particular patient so that even food and hydration could be considered inappropriate at certain times as long as the patient was still comfortable and pain-free. The guiding force here would primarily be the clearly stated desires of the patient or the person he or she has designated to act on their behalf.

Journal: Situations That Forced You to Look at Mercy Killing

Why have dramatic advances in medicine forced us to take an increasingly harder look at allowing someone to die, mercy death, and mercy killing? Substantiate your answer with specific examples.

10.4: Patient Self-Determination Act

1. 10.4 Analyze the patient self-determination act

LISTEN TO THE CHAPTER AUDIO:

In 1990, the U.S. Congress passed the Patient Self-Determination Act (PSDA) as a part of the Omnibus Reconciliation Act (OBRA, 1990). The PSDA requires that health care providers inform patients of their rights to make health care decisions and to execute advance directives. It also requires health care providers to educate their staff and community regarding these rights. The following are some of these rights:

1. The right of patients to considerate and respectful care.

2. The right of patients, in collaboration with their physicians, to make decisions involving their health care, including the following:

   1. (a)The right of patients to accept medical care or refuse treatment to the extent permitted by law and to be informed of the medical consequences of such refusal.

   2. (b)The right of patients to formulate advance directives and appoint a surrogate to make health care decisions on their behalf to the extent permitted by law.

3. The right of patients to acquire the information necessary to enable them to make treatment decisions that reflect their wishes.

In connection with item 2b, even though advance directives had existed long before, until the effective date of the PSDA (December 1991), there was no requirement that patients be informed that they could execute an advance directive. This directive would eliminate the confusion surrounding PVS patients, especially when family and caregivers are trying to decide on appropriate treatment.

Three extremely famous cases concerning patients in a PVS have focused the attention of millions of people in the United States on the importance of executing advance directives. They are the cases of Karen Ann Quinlan of New Jersey, Nancy Cruzan of Missouri, and Terri Schiavo of Florida. Interestingly, despite these real-life events, people are not executing advance directives to the extent they should be, probably because they don’t want to deal with their deaths and dying.

Karen Ann Quinlan

Karen Ann Quinlan was 20 years old when she stopped breathing long enough for a part of her brain to be destroyed; she then lapsed into a PVS. She was put on a respirator, but her parents wanted her to be in a natural state without any artificial means of life support; therefore, they petitioned the hospital and doctors to remove the respirator, which they refused to do. After a lengthy court trial that eventually went to the New Jersey State Supreme Court, Quinlan was taken off the respirator and allowed to exist with just simple bed and body care and food and water.

She continued in this PVS for another ten years, finally succumbing to pneumonia while residing in a skilled nursing facility. It should be made clear that at no time was Karen ever brain dead. She would sit up, thrash about in her bed, react to sound, light, and touch, but at no time was she conscious or aware of her surroundings or the people in them.

Journal: Karen Ann Quinlan Case

After Karen Ann Quinlan was taken off life-support, she lived for 10 years in a persistent vegetative state. Do you think the court would have made the same decision had they known the result? How will this judgment affect the judgment of similar cases in the future?

Submit

Nancy Cruzan

Another woman, Nancy Cruzan, 25, lay in a PVS for seven years following a serious automobile accident. She was fed through an abdominal tube, and her parents asked that the tube be removed and that Nancy be allowed to die her own natural death. This case was litigated up to the Missouri State Supreme Court and finally to the U.S. Supreme Court. Because Nancy had not executed any sort of advance directive, the U.S. Supreme Court ruled that “clear and convincing evidence” that Nancy desired to refuse treatment was lacking, and therefore that it could not and would not rule that her parents had the right to act as her proxies in such a decision.

When her case was returned to Missouri, after hearing further testimony from several of her friends and acquaintances that Nancy had made clear that she did not want to continue in such a state, a Superior Court judge ruled that this additional testimony provided “clear and convincing evidence” of her desire to refuse treatment and ruled that the feeding tube could be removed. It was, and she died several weeks later.

Incidentally, to indicate the great strain and sorrow caused by dealing with the allowing to die of a loved one, on August 17, 1996, her father, Lester “Joe” Cruzan, at age 62, committed suicide by hanging himself in his carport. He had fought depression all his life, and Nancy’s accident, her coma, her lack of recovery, and the strain of fighting for seven years to get the law to allow her to die finally took their toll. According to family and close friends, he did not commit suicide because he felt guilty about fighting for Nancy’s right to die, nor did his suicide note indicate this in any way.7

Terri Schiavo

Probably the most notorious PVS patient of extensive media hype was Terri Schiavo because Michael Schiavo, her husband, wanted her feeding tube removed, whereas her parents, Mary and Bob Schindler, wanted the feeding tube left in. The Schindlers claimed that Terri smiled and looked at them with love in her eyes. However, a distinguished neurologist, Ronald Cranford, examined her with the following results: The CAT scan showed a massive atrophy of the brain. What Terri Schiavo manifested was a classic vegetative state. It looked as if she was looking at you, but really she was not. It looked as if she was grinning at you, but really she was not. The key test is whether someone can track movement, which Terri did not. An examination of Terri’s video tape showed that she was really not looking at her mother. She was really not tracking. Despite this information, many people still argued that her brain was alive. After spending many years trying to improve her condition, Michael stated that he wanted her feeding tube removed. The Schindlers said she was alive despite Dr. Cranford’s expert opinion and that they wanted the feeding tube left in. There then followed the strangest series of events involving various arms of government. First, the governor of Florida, Jeb Bush, the president’s brother, asked the Florida legislature to give him the power to keep Terri alive, which they did. The courts still insisted that her feeding tube be removed. Then Republicans in Washington passed similar legislation, and President Bush flew to Washington, D.C., to sign such a bill into law. Never before had politics played such a part in what was a personal matter, and many decried such interference. Despite the interference, the feeding tube was removed per her husband’s request. Why do you think the confusion existed between Dr. Cranford’s expert opinion and how Terri appeared to nonmedical people? To what extent do you feel government should interfere in such issues? Why is PVS so difficult to deal with compared to brain death? What’s the difference between the two?8 The Quinlan and Cruzan cases, and others like them, have fostered a sense of urgency concerning the rights of people to determine their own treatments and deaths and have led to the creation of the previously mentioned PSDA and to encouraging people to execute advance directives.

Because dying patients do not as a rule need extraordinary medical care, they often can be treated at home. Whenever possible, the hospice approach encourages dying patients to remain at home, offering both patients and their families total care and support from the entire team whenever it is needed. This brings greater comfort to the patients by allowing them to stay in familiar surroundings with their families and their own favorite belongings around them. The key to this type of care, of course, is that complete support and care must be made available by the team. One of the reasons more people have not chosen to die at home, especially in our country, is that there has not been support available to patients and their families, and families aren’t always able to cope alone with all of the problems that surround the dying of a loved one. If the support is there, however, then the home often is the place where patients receive the best care and are the most comfortable.

When home care coupled with outpatient care is not feasible—and many times it is not—humanized, homelike, comfortable inpatient facilities should be available. Patients should be placed in care units or wings so that they can relate to others in similar situations. The rooms should be warmly decorated and should have large floor-to-ceiling curtained windows and at least partial carpeting. Patients should be allowed to have their own familiar belongings around them (easy chairs, plants—even pets, where feasible), and visiting hours should be liberal, with no restrictions on age so that children can visit their parents and grandparents. Food and drink of the patients’ choice (including alcoholic beverages if desired) ought to be available. And, finally, patients should be kept pain- and symptom-free and be given loving care, but they should be spared the intrusion of extraordinary or inappropriate medical technology, such as intravenous lines, respirators, and so on.

All hospice care, in- or outpatient, should be performed on a nonprofit basis. Where available, existing medical insurance, private or government, should pay for as much as possible, but no hospice patient should be refused treatment because of lack of finances. Nor should patients be dunned for money. Many hospices will tell patients and their families how much their care costs and ask them if they can contribute anything toward their care, but usually they are asked only once and never refused treatment because they have no money. Hospices derive their financial support mainly from fund-raising activities, grants, and donations or memorial gifts. Also, it has been proved that keeping dying patients at home on an outpatient basis or even in hospice facilities is far less expensive than keeping them in convalescent homes or acute care hospitals. This is not the main reason that one should consider the hospice approach, however; rather, what is impressive is the humane and compassionate care it provides for dying patients and their families.

Helping dying patients and their families to adjust to the fact of death before, during, and after its occurrence is an important part of the hospice approach. This is yet another reason that the team approach is used—so that social workers, clergy, trained volunteers, and other nonmedical members of the team can aid medical personnel in caring for the entire family unit. Too often in our society the patient is cared for and the family is forgotten. When the patient dies, however, the grieving family remains, and often its members experience tremendous difficulty when dealing with the death of their loved one. If the family and the patient can be treated as a unit during the dying period, then much of the difficulty that might occur after the patient dies can be averted—that is, family members can go through at least some of their mourning while the patient is still with them.

The hospice approach allows patients to die their own natural deaths in peace and dignity and with the full support of their families, friends, the medical community, and society in general. Because two of the main reasons for mercy death and mercy killing are to put people out of their pain, suffering, misery and to end lives that allegedly have no meaning, the hospice approach obviates the need for such measures in most instances. If patients can die in peace and dignity, free from pain and suffering, they will have no need to commit suicide, assisted or otherwise, or have their lives of despair terminated for them. The reasons for mercy death and mercy killing have not been completely eliminated, but a humane alternative does exist in many of those cases that might call for such drastic measures.

The following cases all deal with difficult decisions that must be made with respect to the moral issue of allowing someone to die. This issue arises when choices must be made either to not start curative treatment when no cure is possible or to stop treatment that offers no hope for a cure. Thus, a human being is allowed to die “naturally” without medical or technological interference.

A 38-year-old nurse gave birth to a baby girl who had both Down syndrome (a disease that involves mental retardation) and an intestinal blockage. This type of birth often occurs in women over age 35. The nurse and her husband agreed that the child’s existence would be poor in quality because of her mental retardation, and, knowing that she would die if the intestinal blockage weren’t removed, they refused to sign a permit for surgery to remove the blockage and told the doctors to do nothing to save their daughter. The doctors and the hospital agreed that the parents had the right to make this decision, so the child was left in the nursery to die. After 11 days, she died of starvation.

Another woman, age 42, was rushed to the hospital to have her baby, but the little girl was born in the car on the way to the hospital. The child was born with Down syndrome, intestinal blockage, and a hole in her heart that made it very difficult for her to breathe. The woman and her husband already had three children and had not planned for this one. Because of these problems, they also had both financial and marital difficulties. They refused to sign the permission form the doctors needed to remove the intestinal blockage, saying that even if the little girl survived this surgery, she still would have to have heart surgery later on. Furthermore, they said that if she managed to survive the heart surgery, she would still be severely mentally retarded. The doctors disagreed with the parents, and after obtaining a court injunction allowing them to operate, they removed the blockage. The parents did not even name their daughter, and they refused to take her home until the pressure put upon their other children by their peers forced them to do so. A year later the little girl was still alive, but because of her heart defect she often had to gasp for breath. The parents were so unhappy with the situation that the mother even contemplated smothering the infant with a pillow, but she could not bring herself to do it. The family’s financial situation was deteriorating, and the mother was concerned because the longer they kept the baby, the more everyone in the family was becoming attached to her and the harder it would be for them all if the baby were to die. The parents blamed the doctors and the judge who handed down the injunction for creating this nearly unbearable situation.

1. Both of these cases are quite similar except that the second baby has an additional serious defect, the hole in her heart. Should this make a difference?

2. Which set of medical personnel do you feel did the right thing? Explain your answer, giving specific reasons.

3. How would you resolve the conflicts among the following rights involved in these two cases?

   1. (a)The right of the babies, regardless of their problems, to medical care that could save their lives.

   2. (b)The right of parents to decide whether their defective or deformed babies should be allowed to live when, in the past, they would not have lived because our medical technology was less advanced.

   3. (c)The doctors’ and hospitals’ right to save lives when they know they can.

   4. (d)The conflicting rights of society to (1) protect its members (in this case, the babies) and allow them to live and (2) not be burdened with defective and deformed children when the omission of extraordinary care would allow the children to die of natural causes.

4. In the first case, how do you feel about the fact that the baby was left for 11 days to die of starvation? Do you feel she should have been immediately and painlessly killed instead, or do you feel she should have been operated on regardless of the parents’ wishes?

5. If parents do not wish to take the responsibility of raising children who have defects and deformities, do you feel society as a whole has an obligation to give such parents extensive financial and social aid in raising the children or to assume the responsibility for raising such children itself?

6. If society or the parents have to institutionalize such children in places where bare maintenance is all the children receive, do you think it would be better to allow the children to die, as in the first case?

7. To what extent do you think that not performing what is a relatively simple and safe surgery on a deformed or defective child amounts to unfair discrimination against handicapped children?

A man accused of beating his 11-year-old stepdaughter to the point where she is in a PVS asked judges on the case to allow him to have a say in continuing or discontinuing life support. She is currently on a respirator and a stomach feeding tube. The judges were sceptical about his request. If the judges have the respirator and the feeding tube removed, one interesting consequence is that if the girl dies, then the stepfather could be tried for murder. If you were a judge on this case, how would you rule? Are there any circumstances where you might rule in the man’s favor? What would they be?10

1. 10.6 Evaluate the arguments for and against mercy death

The phrase “mercy death,” as stated earlier, means a direct action taken to terminate someone’s life at his or her request—it amounts to an assisted suicide. Patients, often because they are in pain or because they just do not want to live longer, ask to have their lives ended immediately, usually by some painless means. The motives for such a request vary. Often such patients do not feel they will have the courage to commit suicide and want someone to help them, whereas at other times patients are not able to end their own lives because they either are paralyzed or are too weak to do it themselves. In any case, however, these patients want to be mercifully put to death, not just allowed to die.

In a New York U.S. Circuit Court of Appeals ruling the court did not find that suicide was a constitutional right but found that New York failed to honor the constitutional guarantee of equal protection under the law. According to the court’s ruling, patients on life-support equipment are allowed to hasten their deaths by instructing doctors to turn equipment off, but patients wanting lethal medication are denied it; therefore, the court ruled that any distinction as to the way in which a person chooses to end his own life constitutes irrational and unjustifiably unequal treatment under the law. This decision raises serious questions about the distinction between allowing to die and mercy death.11

Many of the same arguments used against suicide are applicable to mercy death, at least to some extent, but the issues surrounding mercy death are further complicated by the fact that someone else has to do the killing. Thus, it is important to examine the arguments used against suicide as they apply to mercy death.

The irrationality of mercy death argument may have less force here than when it is applied to suicide as people are more likely to accept as rational a decision to die when the person making the decision is to die soon anyway and/or when his or her life at the time of the decision is full of pain, suffering, and misery. Furthermore, even when people who request mercy death are not in imminent danger of dying, their lives may now be so radically altered that they would rather not live anymore (e.g., a physically active person who will be permanently paralyzed from the neck down because of a serious accident). Despite these mitigating factors, however, the argument against mercy death goes on to say that people who are suffering and in pain are in such a state of fear and depression that they simply cannot make rational decisions. If these people will patiently wait to see what therapy and medical science can do for them, the argument continues, perhaps they will adjust to their situation and change their minds about dying.

The criticism of this argument is that many requests for mercy death have come from people who have tried for some time to live with their tragic situation and have still decided that death is preferable to a limited life. Also, it is difficult to argue that because a person is suffering, he or she cannot make a rational decision in favor of death.

The religious argument applies to mercy death in much the same way as it does to suicide. Indeed, it gains force in this case from the fact that a second person must do the killing, which, in religious terms, is even worse than suicide. The religious argument maintains that killing is killing, regardless of the motive, and states that no one has the right to take innocent people’s lives, even at their request.

This argument is further supported by many of our laws. It is true that most states and countries have repealed those laws designating suicide as illegal, but many of them still have laws against helping others to commit suicide. People who do this can, in fact, be charged as accessories to murder. Mercy death does fit our earlier definition of “murder” except that the phrase “especially with malice aforethought” does not apply. Furthermore, it differs from murder in that it is not done against the will of the “victim.”

In addition to the criticisms already presented in rebuttal to the religious argument against suicide, there is another criticism to consider: It is precisely the difference in motive that makes mercy death morally acceptable, especially because the person to be put to death agrees to his or her own death and requests it. Most killings are committed from motives of greed, revenge, anger, hate, or viciousness; mercy death, on the other hand, is done out of love and mercy for a person who is suffering.

Both the domino argument and the criticisms of it apply here in much the same way as they do to suicide, war, and capital punishment. Those who argue against mercy death, however, believe that the domino effect that results from permitting mercy death can be much more pernicious than in those other cases. It is obvious, they say, that if mercy death, which is performed at a person’s request, is authorized or given moral sanction, the next step will be mercy killing; that is, decisions for death will be made by others for those unable to request death for themselves. Once the door is opened for the one, they say, it is open for the other. It is also possible, however, to legally allow mercy deaths and not mercy killings, just as it is legally possible to permit the allowing of someone to die without condoning either mercy death or mercy killing.

Here again, many of the same arguments that apply to suicide apply also to mercy death. There are some additional problems, however. For example, is it just for people to ask others to kill them? Doesn’t this place a terrific burden of guilt and depression on the person who has to perform the act? And what about the feelings of guilt and loss on the part of the family members? Won’t they always wonder whether something more should have been done, perhaps on their part, to help the person live? There is no doubt that mercy death places a greater burden on others than suicide does.

The arguments here are much like those presented in the discussion of allowing someone to die, and they are best characterized by the cliché, “Where there’s life, there’s hope.” The counter arguments also are the same, with the additional criticism that many patients who request mercy death either feel they have no chance of being cured or find the wait for a cure too painful to bear.

In his article “Euthanasia,” Dr. Richard Lamerton has said, “If anyone really wants euthanasia, he must have pretty poor doctors and nurses.”12 He might just as easily have said that the patient must be receiving pretty poor medical care from the entire society. According to the hospice argument, because one already knows that the hospice approach will work, one should exert effort in that direction rather than in trying to discover how to morally and legally justify mercy death or mercy killing. Under the five principles, the hospice approach reveres, preserves, and protects human life; it promotes goodness by giving pleasure and avoiding pain, by creating harmony, by making lives as excellent as they can be, and by allowing and encouraging creativity at whatever level is possible; it provides for honesty and truth telling by dealing with the patients where and as they are and relating to them as real and whole human beings, not merely as diseased bodies; and it gives patients and their families the freedom to enjoy life and each other for whatever time is left, while at the same time allowing them the freedom of a truly dignified death, not by killing but by compassionate treatment.

It seems obvious, then, that if all of these things can be done to alleviate pain and misery and meaninglessness in people’s lives, and if the hospice approach can be made the rule rather than the exception, then the need for mercy death or mercy killing should be decreased a great deal, if not eliminated entirely.

The criticism of this argument is that there may be some patients who do not want any further treatment of any kind, in a hospice or elsewhere, and who choose death rather than a limited life. Furthermore, there are those to whom the hospice approach doesn’t really apply—for example, paraplegics, quadriplegics, victims of paralysis, and other patients who suffer from extremely debilitating chronic, but not necessarily terminal, diseases. In the opinion of such patients, the alternative of mercy death is still viable.

The main argument for individual freedom and rights, as in the suicide issue, is the argument that people ought to have the right to decide when their lives should end. If they choose not to live any longer and request to die, society should oblige them, recognizing that they have made a free, rational choice. All that medical professionals are doing is carrying out their decisions in a spirit of love, compassion, and mercy.

The difference between mercy death and suicide, however, is that in the case of mercy death others are asked to end their lives for them, and this can certainly be seen as an infringement upon our rights and freedom. A doctor expressed this point of view on a television documentary called Right to Die. The doctor said, “You have the right to choose death for yourself, but you do not have the right to involve me in your choice.”

Another argument states that just as people are generally willing to put animals out of their misery when they suffer, so society should accord our fellow humans, who certainly are of higher worth to us, the same consideration. Furthermore, because they have asked us for death, there should be no compunction about ending their lives mercifully.

The main criticism of this argument is that the rights of human beings to live or die are not in any way the same as those of animals. Western religions, of course, maintain that human beings have immortal souls, but even nonreligious humanists talk about the “human spirit,” or personality, stating that it should be accorded a greater respect than the mere physical self.

A counterargument to this is, “Yes, humans and animals are different, but above all this should mean that humans have free will and therefore should be able to decide for themselves whether or not they should end their own lives with or without assistance.”

1. 10.7 Examine changes in attitudes toward mercy death

Several events reflect a change in attitude toward mercy death.

As has been stated earlier, presently mercy death is illegal in many of the 50 states and in most countries of the world, but there is strong advocacy not only for allowing people to die their own natural deaths but also for allowing people to be assisted by doctors in committing suicide when they no longer feel that their lives are worth living (mostly, but not always, when their illnesses are terminal). Two men—Derek Humphry (1930– ) and Dr. Jack Kevorkian (1928–2011)—have been active in furthering the cause of mercy death, or assisted suicide.

Derek Humphry is an Englishman now residing in the United States. In 1975 Humphry, while still living in England, assisted his first wife, Jean, in committing suicide when she was dying of cancer. This was perhaps a somewhat strange action because both of them resided in the country where the modern-day hospice was brought to life. Humphry wrote a book about it called Jean’s Way. In 1980 in California, Humphry founded the Hemlock Society, which is famous for two things:

1. Working to change laws so that doctors can legally help terminally ill patients to commit suicide.

2. Giving advice to people who have decided to die on their own when doctors cannot or will not help.

The Hemlock Society attempted to introduce legislation in both California and Washington that would legalize assisted suicide, but both measures failed. After these failures, Humphry and his second wife wrote The Right to Die: Understanding Euthanasia in 1986. He then wrote his most famous and best-selling book, Final Exit, in 1991, which, as Playboy described it in its interview with Humphry, “is nothing short of the last self-help book you’ll ever need.”13 He has published a fourth book, Dying with Dignity: Understanding Euthanasia. Humphry is currently assisting a group called Californians Against Human Suffering with their initiative, which was on the ballot in California in November 1992 and did not pass.

Dr. Jack Kevorkian, from Detroit, Michigan, is much more famous and controversial than is Humphry. A retired pathologist, Kevorkian has helped over 130 people to commit suicide, few of whom, interestingly enough, could have been classified as terminally ill. He has been brought to trial several times and acquitted of assisting suicide. It should be noted that in all of these cases, Dr. Kevorkian provided the means, but the people themselves administered their own suicides. However, on September 17, 1998, Dr. Kevorkian helped Thomas Youk, suffering with Lou Gehrig’s disease (ALS), to die and videotaped the whole event. He then went on television during 60 Minutes and showed the whole event and answered questions as well. He was found guilty and sentenced to jail for taking Mr. Youk’s life. Kevorkian served eight years on a 10–25-year prison sentence for second-degree murder. He was released on parole in 2007 on the condition that he would not engage in assisted suicides or give advice on such matters. He was unsuccessful in a 2008 run for the U.S. Congress in Michigan’s 9th congressional district. Kevorkian died June 3, 2011.

The first physician-assisted suicide law in effect in the United States was the “Death with Dignity” law in Oregon. The law was first passed in 1994 but was prevented from going into effect by a court injunction; reaffirmed by voters in November 1997, it finally went into effect. Interestingly, a study was done in its first year of 1998, and the fears surrounding the passing of the law were discovered to be unfounded. Only 15 terminally ill people used it to end their lives without suffering any painful, lingering deaths that opponents had warned about.14 Currently, four states have laws allowing physician-assisted suicide.

Dr. Christopher Meyers, director of the Kegley Institute of Ethics at California State University, Bakersfield, California, and an expert in medical ethics who consults with Bakersfield area hospitals, stated in an article in the Bakersfield Californian newspaper, “ . . . who other than a truly desperate person would choose to spend his or her final moments in the back of a Volkswagen van sucking on carbon monoxide, as many of his [Dr. Kevorkian’s] clients have done? What could create such desperation? A realization that soon one will be facing pain and loss of identity and dignity, with little or no control over either the disease process or how one’s final days are to be lived.” He goes on to say that physicians and pharmacists have a monopolistic control over pain medication, and physicians also have the same kind of control over drugs that might hasten death and medical technologies that can vastly improve a dying person’s quality of life: “The point is, when one is gravely ill and/or in need of hospitalization, nearly all aspects of personal control are lost.”15

Dr. Meyers abhors the fact that patients in need of autonomous relief have to turn to a man of such questionable taste and judgment as Dr. Kevorkian, but he also sees no future remedy of the medical establishment granting autonomy to its patients. He therefore believes that physician-assisted suicide should be made a legal option.

It is certainly not unknown that some doctors in the United States and other countries of the world (e.g., Holland and Sweden) have at times practiced some form of assisted suicide. A recent controversial study of 850 nurses revealed that 141 of them had received requests from patients or family members to engage in assisted suicide. One hundred and twenty-nine of these said they had carried out these practices at least once, and 35 said they had hastened a patient’s death by only pretending to carry out life-sustaining treatment that had been ordered.16 Despite the inconclusiveness of the study and the small sampling of nurses surveyed, the answers of the nurses are indicative of their need to help patients when they are in pain, deteriorating, and dying. Some nurses have said that if the real facts were known, the figures would be much higher than reported.

There is and has been over the last ten years a greater desire on the part of people who are suffering painful, deteriorating, or terminal illnesses to have autonomous control over their bodies and lives. For instance, one of the people who was assisted in suicide by Dr. Kevorkian was a woman, 43 years old, who had discovered that she had Alzheimer’s disease. She wanted to die before she had to suffer as her mental condition deteriorated. Several of Kevorkian’s “patients” had muscular dystrophy and were tired of trying to live such a limited, handicapped existence. None of these people was a terminal case, but many patients who are terminal, due to cancer and other fatal diseases, also have requested the right to choose not to suffer any further and want to be able to have physicians help them die.

1. 10.8 Outline the key suggested safeguards for mercy death

Whether or not any of us believes that mercy death is morally justified, it seems inevitable that in the future, near or distant, it will become a widespread practice that is partially or completely legal. It is important, therefore, that some careful legal safeguards be proposed before this happens; otherwise, ethics and the law may be caught by surprise, as they have been already by the actions of Dr. Kevorkian and the two circuit courts of appeals’ decisions. Besides, as columnist Ellen Goodman (1941– ) has said, “Most Americans support legal, assisted suicide for the most personal of reasons. We just might want it someday.”17

The Oregon law allows doctors to write prescriptions for aware adult, terminally ill patients who have asked for them both orally and in writing. There is a 15-day waiting period; two witnesses and a second doctor are required; patients must be informed about other options; and they must take the drugs themselves. On January 17, 2006, the Supreme Court voted to uphold Oregon’s physician-assisted suicide law.

In Dr. Christopher Meyers’s discussion of the lack of autonomy problem and physician-assisted suicide, he has presented several safeguards:

1. The first request for death assistance must occur at least two months prior to the provision of such assistance.

2. The request must be repeated twice more in two-day and one-week intervals.

3. All requests must be initiated by the patient and cannot come as the result of a question from any other party.

4. All requests must be witnessed in writing by someone who has no economic interest in the patient’s life or death and who can attest that the request appears to be made by a competent person who is not under undue influence from medications or from pressure from family or loved ones.

5. The request for death assistance must be reversible at anytime. The patient must be informed that such a reversal, if it were requested during the death-assisting procedure, could worsen his or her medical condition.”18

O. Ruth Russell (1946– ), in her article “Moral and Legal Aspects of Euthanasia,” published in 1974 in the Humanist magazine, states her belief that:

1. Any law legalizing physician-assisted suicide should be permissive rather than mandatory or compulsory.

2. There can be no secrecy.

3. There has to be a written, notarized request.

4. An advisory panel is to be used.

5. Several doctors must be involved.

6. A waiting period will be required; and

7. It will be a criminal offense to falsify any documents, coerce patients or next of kin, or perform any malpractice involving any act of euthanasia.

Most of the safeguards mentioned earlier are significant, but some are more necessary than others, and there may be additional ones that should be included. The following safeguards should be a part of any law that permits physician-assisted suicide.

Any law that authorizes physician-assisted suicide should, of course, be permissive rather than mandatory. No one but the person desiring assistance or his or her designated agent should request it. Further, no one should be forced or coerced in any way to request such assistance, and physicians or other health care personnel should not be required to carry out any such request against the dictates of their moral conscience.

There must be no secrecy involved. Everything must be done in the open and aboveboard. Any such request should be made in writing by the person requesting, and this request should be witnessed by disinterested persons and notarized. An advanced directive could be used for this purpose, or additional pages or sections could be added to them, although it may not be necessary that such requests be notarized. Any such request can be revoked by the patients or their designated agents at any time, either orally or in writing, but patients should be warned, as Dr. Meyers suggests, that revocations after the process has begun may result in the worsening of the patients’ condition.

There should be a waiting period, and Dr. Meyers’s suggestion of two months, from the time of request to actually providing assisted suicide, is a fair one. Meyer’s insistence on the necessity of repeating the request two days later and one week later and perhaps one month later as well is sound. There could be places provided on any form used where patients or their agents could repeat or verify the initial request. Before and during this waiting period, other options, such as hospice care, appropriate pain control, and whatever other appropriate care is available, should be carefully explained.

Also, before and during the waiting period, a trained counselor should be made available to aid patients in making their decisions and to ensure that they are rationally competent to request assisted suicide and are not being forced or coerced in any way by families, friends, or health care personnel. If there is a serious question of mental competency, psychiatrists or psychologists could be called in to present their findings.

More than one doctor should be involved in the diagnosis and prognosis of patients’ illnesses and lives, and patients will have to be fully informed concerning their condition.

Any coercion of patients or next of kin, falsification of documents, or performance of any malpractice involving any act of mercy death should be deemed criminal offenses punishable by law.

It should go without saying that any mercy death or assisted suicide should be painless (which is why physicians should administer it) and performed in a comfortable, pleasant place of the patient’s choice.

Additional safeguards could involve having a judge or court commissioner approve the mercy death after hearing and seeing all of the evidence including the patient’s own words if that is feasible. If not, then the words of patients’ families and designated agents should be heard. Also, there could be, as Ms. Russell has suggested, a panel or committee, such as a bioethics committee, of disinterested persons, that could hear and see all of the evidence and advise all those involved. Either of these, especially the court situation, could prove to be restrictive of patients’ autonomy, but either certainly would make it harder for a questionable mercy death to be carried out.

Neither mercy death nor physician-assisted suicide is being advocated here but merely practical suggestions for legal safeguards. What would pretty much eliminate the need for these actions is an expansion of the hospice approach, especially as it involves pain and symptom control. It is probable that if suffering people, terminal or otherwise, were rendered as free as possible of pain and discomfort, there would be less need for mercy death, physician-assisted or otherwise. Yet to establish a more sensible approach to pain and symptom control would require radical changes in the training of physicians and to a lesser extent pharmacists. These professionals would then have to give autonomy to those patients and their families who are now in real need of such control. Dr. Meyers thinks it is unlikely that such changes will take place in the near future, and as long as they don’t, people will continue to request assisted suicide and to seek out people such as Dr. Kevorkian. If mercy death is to be allowed and legalized, then there needs to be a guarantee that it will be conducted as morally and legally as possible.

Mercy death refers to voluntary dying or assisted suicide. Strong moral arguments are presented both for and in opposition to issues concerning mercy death. Opponents argue that when a third party must do the killing, then the issue becomes murder. And, they contend murder is never justified. Arguments against mercy death often point to the fact that, very often, there are other less extreme alternatives, for example, hospice care. On the other side of this issue, people typically cite the individual’s freedom to decide their own deaths.

A truck overturns on one of our major highways, and the engine catches on fire, engulfing the cab, where the driver is trapped. A highway patrol officer arrives on the scene and realizes that no one can get near enough to the cab to get the driver out. The driver sees the patrolman and begs the officer to shoot him so that he won’t have to suffer the horror of burning to death. The officer is close enough to kill him instantly. What should he or she do?

A 24-year-old man named Robert who has a wife and child is paralyzed from the neck down in a motorcycle accident. He has always been very active and hates the idea of being paralyzed. He is also in a great deal of pain, and he has asked his doctors and other members of his family to “put him out of his misery.” After several days of such pleading, his brother comes into Robert’s hospital ward and asks him if he is sure he still wants to be put out of his misery. Robert says yes and pleads with his brother to kill him. The brother kisses and blesses Robert and then takes out a gun and shoots him, killing him instantly. The brother later is tried for murder and acquitted by reason of temporary insanity. Was what Robert’s brother did moral? Do you think he should have been brought to trial at all? Do you think he should have been acquitted? Would you do the same for a loved one if you were asked?

A 67-year-old woman has been sick for the last ten years with heart, lung, and kidney problems that have given her a great deal of pain and discomfort. In her own words, her life is “a misery” and “not worth living.” Her children all are grown, and she lives alone with her husband, who is 68. She has talked with him on several occasions during the past two years, begging him to help her to die. She has told him that she is tired of living and that she gets no pleasure from her life anymore. On this particular morning, they discuss her life and death for four hours, and again and again she begs him to help her to die. Finally, he gives in to her wishes and takes her out to the garage, puts her in their car, turns on the engine with the garage door closed, and goes back into the house for about an hour. At the end of the hour, he takes her out of the car, calls the police, and tells them what he has done. They arrive on the scene and arrest him for murder. Did the husband do the right thing? Did the wife have the right to request this action of her husband? Did he have an obligation to satisfy her request? Should he have been arrested?

Dr. Kevorkian originally invented a suicide machine that he could hook up to an intravenous line that is inserted into a person’s arm, so that the person can push a button or release a clamp and administer a fatal but painless dose of chemicals. More recently, he used carbon monoxide that the people can inhale until they die. Few of the people who used his machine or the carbon dioxide were terminally ill people. For example, one 43-year-old woman had just been diagnosed as having Alzheimer’s disease, one had severe pelvic pain, and another had multiple sclerosis. Do you think that what he was doing was moral or immoral? Why? Would it make any difference to your decision if the people had been terminally ill? Do you agree with what was done to the doctor legally? Why or why not? If you were asked by someone you loved to help him or her die, and you had the means, like Dr. Kevorkian, to do so, what would you do? Why? Would you like doctors to have the right to assist people in committing suicide? Why or why not? Would the people have to be terminally ill, in your opinion, or not? Why?

1. 10.9 Evaluate the arguments for and against mercy killing

Mercy killing is similar to mercy death in the sense that it involves a direct action taken to end someone’s life; the difference is that mercy killing is not done at the person’s request. People who perform mercy killing may assume that the person they are going to kill wants this act to be done, but they don’t know for sure, nor do they have the person’s explicit request or permission to perform the act. Very often the decision to go ahead with a mercy killing is based upon a belief that the “victim’s” life is no longer worth living because he or she is existing as a mere mindless organism, not as a full human being.

Therefore, mercy killing can be defined as the termination of someone’s life, without that person’s explicit consent, by a direct means, from a motive of mercy; that is, in an attempt to end suffering and/or a “meaningless” existence. Obviously, the greatest moral problem associated with mercy killing is that, as opposed to allowing someone to die mercy death, in this case the patient’s consent cannot be obtained nor can his or her desires be known for sure. Mercy killers must come to a decision about someone else’s life without the person’s permission or acquiescence.

Many of the arguments that have been used in relation to mercy death and allowing someone to die apply also to mercy killing. Again the main aspect that distinguishes mercy killing from the other two categories is the lack of consent on the part of the “victim.”

Mercy killing is a direct violation of the value of life principle, especially because, unlike defense of the innocent, war, and capital punishment, it usually involves taking the life of an innocent person. As in the mercy death situation, the argument here is that murder is murder regardless of motive; therefore, mercy killing is nothing less than premeditated murder. This argument is even more convincing here than in the case of mercy death because in this case people either haven’t given or can’t give their consent to having their lives terminated.

Because the consent of patients cannot be obtained, an outside decision about the worth, value, or meaning of their lives has to be made, and according to this argument against mercy killing, this sets a dangerous precedent. In the first place, who has the right to decide whether any person’s life is worthy, has value, or is meaningful? What standards are to be used when making such a decision? Won’t the sanctioning of such an action set a dangerous precedent for the elimination of old, senile people, for example, because they may be considered useless by a youth-oriented society? Can we allow such decisions to be made? If so, by whom should they be made? This is certainly one of the more serious problems related to mercy killing, and it is one that does not affect either allowing someone to die or mercy death to so great an extent. In both of the latter cases, the individual decides what the worth of his own life is, whereas in mercy killing one person.

Both this argument, which states that mercy killing should not be authorized because cures may be found, and the criticism of this argument are the same as those for allowing someone to die and mercy death.

The main argument for mercy killing is that it is not a violation of the value of life principle because in most cases the people killed are not fully alive as human beings; rather, they are existing as mere organisms, a network of organs and cells. It is an act of mercy, a proponent of mercy killing might argue, to end the life of those people, who, although not brain dead, have suffered 80 percent brain damage. Even if such people recover from their comas, the damage to their brains is so extensive that their lives will never again be normal. They will have a plantlike existence, exhibiting no personality or real human consciousness whatsoever; therefore, it is an act of mercy to end their existence.

The main criticism of this argument is that one actually is murdering such people. Because they cannot be declared dead under any acceptable medical or legal criteria, a dangerous precedent is set when someone is sanctioned to directly end their lives. It is one thing to allow them to die by refusing to use any extraordinary means to save them if they are attacked by pneumonia or kidney or heart failure; it is quite another, however, to directly murder them, even out of a motive of mercy.

People with extensive brain damage, along with many other sick and injured people, are financial and emotional burdens upon their families and on society. Such burdens often are tremendous, and, some argue, they serve no significant purpose because patients in such situations gain absolutely nothing from their maintenance except the continuation of what is assumed to be a minimal and worthless existence.

The main criticism of this argument is that finances should not be a determining factor where human life is concerned. It is true that the emotional burden often is difficult to bear, but here again we should not sanction the sacrifice of one human life simply to ease the emotional burden upon another.

Another argument for mercy killing is that if patients with brain damage could communicate with us, they would say that they would rather be killed than linger on as burdens to their families and society or to exist as organisms without consciousness.

The main criticism here, however, is that we cannot know any of this for certain because the patients cannot communicate. It is possible that advance directives could be revised so as to include mercy killing as well as allowing someone to die, but it might be very difficult to get such documents legalized. Faced with such a directive, the state probably would feel that it had the obligation to preserve and protect human life rather than authorize the execution of innocent people, regardless of the status of their existence.

One of the strongest arguments against both mercy death and mercy killing is that if such actions were sanctioned they undoubtedly would be abused. For example, if it were legal to perform mercy killing on people who had reached a certain point in their illness or a certain age, wouldn’t such a law invite abuse by people who wanted such things as organs to transplant, inheritances, or the elimination of personal financial burdens, and couldn’t it become an instrument of revenge or of other motives usually connected with killing that is not “mercy” oriented? But, again, it is possible to establish safeguards similar to those that have been suggested for mercy death or assisted suicide.

The main criticism of this argument is that although most of these safeguards provide for mercy death, few of them would be of any use in protecting people against mercy killing against their wills. Any legislation that would give power to the state or to certain individuals to take the lives of those who were too “unworthy” or too “useless” to live would be extremely hard to enforce, and there would be little protection for helpless, innocent human lives.

Mercy killing is the termination of someone’s life without that person’s explicit consent by direct means out of a motive of mercy. Is not such killing an act of murder? And, isn’t murder morally wrong? Is not such direct action a clear violation of the Value of Life Principle? Or, as others argue, the motive is not to end the life of an individual but to end their suffering. Each case dealing with mercy killing illustrates some of the complexities in dealing with these end of life dilemmas.

A doctor who was performing a legal abortion on a woman five months pregnant noticed that the “aborted fetus” actually was alive, so he held the fetus’s head inside the woman’s vaginal canal until the fetus suffocated. The doctor’s thinking was that the fetus was intended to be killed or born dead during the abortion, and that its being born alive was an error that could result in an unwanted or deformed child. Therefore, he felt that he had performed an act of mercy. What do you think about the doctor’s action?

Laura, a 19-year-old woman, fell into a coma because of an overdose of drugs and alcohol. She was given emergency treatment at a hospital and was placed on a respirator, which stabilized her breathing. She remained in a deep coma, and when she was tested by neurologists and neurosurgeons it was discovered that about 70 percent of her brain was irretrievably damaged. She was not brain dead, however: She reacted to pain, her eyes sometimes would open and her pupils contract, she would at times thrash about, and her EEG showed some brain activity. She was in a PVS. Because she could not be pronounced dead in any medical or legal sense, the hospital and doctors refused to take her off the respirator or to stop any other treatments they were giving her. At one point Laura’s sister was alone in the room with her and, thinking that Laura wouldn’t want to live on in this way, she disconnected the respirator and caused her sister’s death. Discuss in detail your reactions to the sister’s decision.

Before much was known about Tay-Sachs disease, Betty and Irv, a young Jewish couple, gave birth to a son who had this disease. They were told by their doctor that the boy would become very sick and slowly degenerate over a period of about a year, and then he would become blind and suffer convulsions. They were also told that there is absolutely no cure for the disease and that their son was sure to die. After watching the child for about six months, Irv was not able to stand it any longer. He put a pillow over his son’s face and suffocated him. Under these circumstances, do you feel that Irv was justified in performing a mercy killing? The couple wanted another child. Given that they have a one-in-four chance to produce another Tay-Sachs child, what should they do?

A 75-year-old man in Florida, a state containing many retired and sick senior citizens, shot his wife twice in a mercy killing. The wife was suffering from Alzheimer’s disease and osteoporosis (a degenerative bone disease). The couple was well off because the husband was a retired engineer. He had hired several women to care for his wife, who often was disoriented, irritable, and confused. The wife did not deal well with these women and was constantly embarrassing her husband by showing up in public, sometimes half-dressed and confused. One day she sought him out at a condominium owners’ meeting and was particularly confused and troublesome. He took her back to their condominium and sat her down on a couch. He then picked up a pistol he owned and shot her in the back of the head once and then a second time because he thought she might still be alive. The man was arrested for murder in the first degree, tried, convicted, and sentenced to a minimum of 25 years in prison (Florida law for a first-degree murder conviction).

Several points about this case should be noted:

1. There was no evidence that his wife had asked for death, nor that he had asked her if that was what she had wanted.

2. He showed very little remorse in court, stating that he believed he had acted morally.

3. The prosecuting attorney stated that the husband’s sentencing was correct because allowing him to go unpunished would set a dangerous precedent in Florida: Any time confused or sick old people become hard to care for or deal with, someone could mercy kill them with impunity.

4. Despite being well off, at no time did the husband look into or attempt to place his wife in one of the many facilities established to care for Alzheimer’s patients.

Because the husband was 75 and not well, many people, including his daughter, thought that his sentence should be commuted or that he should be pardoned because he would probably die in prison. His case was referred to a commission appointed by the governor to make recommendations concerning the husband’s situation, but the commission ruled that he should remain in prison. Several years later the governor commuted his sentence, and he is now out of prison. Do you think that what the husband did was moral or immoral? Why? Do you think this case was handled correctly? Why or why not? Do you feel that the husband should have been prosecuted at all? Why or why not? Do you feel that he tried all available alternatives before killing his wife? If not, what should he have done? Do you think his sentence should have been commuted or not? Why? How is this case different from the preceding cases we looked at in the mercy death section of this module? Are the other cases more justifiable than this one? Why or why not?