In Moral Philosophy, we discussed Meta-Ethics and Normative Ethics. Meta-ethics, if you recall, addresses questions about the nature of ethics itself, while Normative Ethics focuses on the ethical standards (norms) on which moral conduct is based.  Now we are going to consider the third area of Moral Philosophy - Applied Ethics.  In Applied Ethics, philosophical theory is applied to practical issues such as euthanasia and abortion.

For our purposes, euthanasia can be defined as the killing of a person for the sake of that person. Euthanasia may be voluntary, non-voluntary, or involuntary. The differences between these three categories depend upon whether the request to die has been made by the person being killed. In voluntary cases the individual does make the request, whereas, in non-voluntary cases, the individual is not in a position to make the request (e.g. permanent vegetative state). Involuntary euthanasia is where the person is able express an opinion but is either not consulted or expresses a desire to live.  These latter cases of euthanasia  are rare but there are some examples – can you think of one.

It is often held that there is a crucial distinction between killing and letting die; the former is an act, while the latter is an omission (Acts and Omissions Doctrine).  In line with the Acts and Omissions Doctrine (AOD) there is then a further distinction to be made in cases of euthanasia.  Active euthanasia is when some deliberate action brings about the death (e.g. lethal injection), whereas passive euthanasia is when the death is the result of an omission (e.g. not resuscitating).  According to the AOD passive euthanasia may sometimes be permissible but active euthanasia is always forbidden. This distinction informs clinical practice in Scotland and is also apparently endorsed by law, but it is not itself uncontroversial.

James Rachels, in his ‘Active and Passive Euthanasia’, provides the following example, which he believes provides a challenge to the AOD:

Smith stands to gain a large inheritance if anything should happen to his six-year-old cousin.  One evening while the child is taking his bath, Smith sneaks into the bathroom and drowns the child, and then arranges things so that it will look like an accident.

Jones also stands to gain if anything should happen to his six-year-old cousin. like Smith, Jones is planning to drown the child in his bath.  However, just as he enters the bathroom Jones sees the child slip and hit his head, and fall face down in the water.  Jones is delighted, he stands by, ready to push the child’s head back under if it is necessary, but it is not necessary.  With only a little thrashing about, the child drowns all by himself ‘accidentally’, as Jones watches and does nothing.

In this case Smith has killed his cousin, whereas Jones has ‘merely’ let the child die. As such, according to the AOD we should find that there is a moral difference in the actions of both men.  But do we?  Is Jones’ act less reprehensible than Smith’s because he (Jones) ‘didn’t do anything’? Rachels believes that there is no discernible difference in the moral status of both men and, therefore, the distinction between killing and letting die is irrelevant.  As such, the AOD is flawed and ought not to apply in the case of euthanasia, especially given that there are many cases in which active euthanasia is more humane than passive euthanasia.

In order to examine the AOD more closely let us turn to the famous ‘Trolley car problem’ (Philippa Foot, Judith Jarvis Thomson):

On your morning walk, you see a trolley car hurtling down the track, the conductor slumped over the controls. In the path of the trolley are five men working on the track, oblivious to the danger. You are standing at a fork in the track and can pull a lever that will divert the trolley onto a spur, saving the five men. Unfortunately, the trolley would then run over a single worker who is laboring on the spur. Is it permissible to throw the switch, killing one man to save five?

Consider now a different scene. You are on a bridge overlooking the tracks and have spotted the runaway trolley bearing down on the five workers. Now the only way to stop the trolley is to throw a heavy object in its path. And the only heavy object within reach is a fat man standing next to you. Should you throw the man off the bridge?

Consider next, a further example similar to the second case:

A brilliant transplant surgeon has five patients, each in need of a different organ, each of whom will die without that organ. Unfortunately, there are no organs available to perform any of these five transplant operations. A healthy young traveller, just passing through the city the doctor works in, comes in for a routine checkup. In the course of doing the checkup, the doctor discovers that his organs are compatible with all five of his dying patients. Suppose further that if the young man were to disappear, no-one would suspect the doctor.

Think closely about each situation.  Most would, I think, say that in the first case it is permissible to throw the switch. [Note here that according to the Acts and Omissions Doctrine we must let the five die rather than killing one].  What do you think?  What about the fat man on the bridge?  Why might someone feel that the switch should be thrown but the fat man should not be?

A possible way of gaining insight into these cases is by way of a further doctrine: the Doctrine of Double Effect (DDE).  The DDE can be traced back to Aquinas, who states:

One and the same act can have two effects, only one of which is intended, while the other is outside the intention.  Now moral acts are categorized in accordance with what is intended, not what happens outside the intention, since this is incidental . . .  The act of defending oneself may have two effects – saving one’s life and killing the aggressor.  This kind of act, since the intention is to save one’s own life, is not impermissible, since it is natural for everything to maintain itself in existence, as far as it can.

What the DDE states, then, is that it is be permissible to act to bring about some morally good outcome, even if your action will also bring about some morally bad outcome, as long as: the good outweighs the bad; the bad was merely foreseen and not intended, and; the bad consequences were not a direct means to achieving the good.

Here then we can see a difference between the first trolley case and the fat man-bridge/ transplant cases.  In the first instance the death of the person on the track was a merely foreseen side-effect of saving five, whereas in the latter cases it was the means by which the end of saving five was achieved.

It also seems the DDE could be put to good use in cases of euthanasia.  For example, when the patient is in great pain and requests that his life be ended a physician could administer a large dose of a pain relieving drug which may also cause the patient’s death.  In addition, the DDE could also be used in particular cases of abortion. For example, where a life-saving operation is required in order to save the mother with the (merely foreseen) consequence of the termination of the foetus.

There are, however, some problems with the DDE.  Consider the following case, again from Philippa Foot (‘The Problem of Abortion and the Doctrine of Double Effect’):

Consider the story, well known to philosophers, of the fat man stuck in the mouth of the cave. A party of potholers has imprudently allowed the fat man to lead them as they make their way out of the cave, and he gets stuck, trapping the others behind him. Obviously the right thing to do is to sit down and wait until the fat man grows thin; but philosophers have arranged that flood waters should be rising within the cave. Luckily (luckily?) the trapped party have with them a stick of dynamite with which they can blast the fat man out of the mouth of the cave. Either they use the dynamite or they drown. In one version the fat man, whose head is in the cave, will drown with them; in the other he will be rescued in due course. Problem: may they use the dynamite or not? … suppose that the trapped explorers were to argue that the death of the fat man might be taken as a merely foreseen consequence of the act of blowing him up. (‘We didn’t want to kill him … only to blow him into small pieces’ or even ‘ … only to blast him out of the cave.’) I believe that those who use the doctrine of the double effect would rightly reject such a suggestion, though they will, of course, have considerable difficulty in explaining where the line is to be drawn.

What Foot is highlighting here is how difficult it is for us to separate a direct aim from an indirect consequence and how this difficulty could, potentially, allow any act to be justified via the DDE.  Suppose, for example, that the terrorists involved in the 9/11 attacks were to argue that their aim was merely to bring down the symbol of capitalism (it is, of course, debatable whether this aim is a morally good one).  Now this aim would have been achieved even if no one was inside the towers or on the planes; their deaths could, therefore, be considered an unforeseen consequence of the intended act.  As such, couldn’t it be argued that by application of the DDE that this action (morality of the aim aside) was justified?

We have already noted how the DDE could, at times, be used in order to justify cases of abortion.  What makes abortion a very difficult issue is that there are two key considerations: the status of the foetus, and; women’s rights. If we ignore the status of the foetus (as do some supporters of abortion), or ignore the question of women’s rights (as do some opponents of abortion) then the abortion issue is simple to resolve.

In philosophy, moral status determines the amount of moral consideration to which an ‘individual’ is entitled. If we grant moral consideration then we act (or refrain) from acting so as to advance that individual’s interests – perhaps at the expense of the interests of some other individual. In order to establish the moral status of the foetus we would have to establish which morally relevant properties (MRPs) are present and at what stage. Moreover, we would need to consider what it is that counts as a morally relevant property.  Jeremy Bentham, for example, takes what should be familiar to you all as a strict utilitarian view:

The day may come when the rest of the animal creation may acquire those rights which never could have been withholden from them but by the hand of tyranny.  The French have already discovered that the blackness of the skin is no reason why a human being should be abandoned without redress to the caprice of a tormentor.  It may one day come to be recognized that the number of legs [etc.] are reasons equally insufficient for abandoning a sensitive being to the same fate.  What else is it that should trace the insuperable line?  Is it the faculty of reason?  Or perhaps the faculty of discourse?  But a full-grown horse or dog is beyond comparison a more rational, as well a a more conversable animal, than an infant of a day or a week, or even a month, old.  But suppose it were otherwise, what would it avail?  The question is not, Can they reason? nor Can they talk? but Can they suffer?

This short extract shows how difficult it is to find common agreement on what exactly is, and what isn’t, morally relevant.  Furthermore, even if we agree that the capacity to suffer is a MRP then we would still need to ascertain, in relation to abortion, at what point a foetus gained this capacity and to what degree.

Judith Jarvis Thomson in her famous article, ‘A Defence of Abortion’ (1971), bypasses such issues and grants her anti-abortionist opponents that the foetus has moral status.  This, however, she believes does not entail that it has an absolute right to life, where this involves the use of the woman’s body.  Thomson provides us with the following thought experiment to guide our intuitions:

You wake up in the morning and find yourself back to back in bed with an unconscious violinist. A famous unconscious violinist. He has been found to have a fatal kidney ailment, and the Society of Music Lovers has canvassed all the available medical records and found that you alone have the right blood type to help. They have therefore kidnapped you, and last night the violinist’s circulatory system was plugged into yours, so that your kidneys can be used to extract poisons from his blood as well as your own. The director of the hospital now tells you, “Look, we’re sorry the Society of Music Lovers did this to you – we would never have permitted it if we had known. But still, they did it, and the violinist is now plugged into you. To unplug you would be to kill him. But never mind, it’s only for nine months. By then he will have recovered from his ailment, and can safely be unplugged from you.” Is it morally incumbent on you to accede  to this situation? No doubt it would be very nice of you if you did, a great kindness. But do you have to accede to it?

JJT has set up this situation in to make a parallel with cases of rape.  Even in such cases anti-abortionists will still assert the the foetus’ right to life is absolute. What do you think?  Do you have a responsibility to the violinist?