Bioethics Summer 2005 University of Toronto Prof. Kirstin

Bioethics Summer 2005 University of Toronto Prof. Kirstin

Bioethics Summer 2005 University of Toronto Prof. Kirstin Borgerson [email protected] Room 359S Munk Centre Office Hours: Tuesday 3-5pm and by appointment Review/Preview Course specifics: Website and notes: Lecture format:

Monday 6:10-7:15 [break] 7:30-8:30 Wednesday 6:10-7 [break] 7:10-8 Midterm Exam (returned July 13 in tutorial) Essay (topic: July 13, due: July 27)

Final Exam (week of Aug. 15-19) Tutorials (continue) Office hours and *location 359S* Structure of the course Hippocratic Oath Methodology: reflective equilibrium Theories Principles Specific Cases Suicide

Lecture 1 Outline: 1. Suicide definition 2. Kants arguments against suicide 3. Brandts pilot case 4. Brandts rebuttal of common arguments against suicide 5. Brandts arguments against absolute prohibition on suicide 6. Moral obligations of others

7. Implications of a general principle of moral obligations to others Suicide The intentional termination of ones own life (382) Can be passive (refusing to eat) or active (overdosing on drugs) Are there conditions under which suicide is morally justified? Which conditions? Kant/Brandt

Deontological position (Kant): suicide is in no circumstances permissible (388) Utilitarian/Consequentialist position (Brandt): suicide is sometimes morally acceptable (391) Kant Recall: an ethics of respect for persons

Act in such a way that you always treat humanity, whether in your own person in the person of any other, never simply as a means, but always at the same time as an end (18) To use life for its own destruction, to use life for producing lifelessness is selfcontradictory (388) Kant Irrationality Argument (Selfcontradiction)

1. 2. 3. 4. 5. 6. Ones embodied life is the condition of any choice one makes Suicide destroys ones embodied life Ones embodied life is the condition of the suicide choice [from 1] Suicide destroys the condition of ones suicide choice [from 2,3] Any choice that destroys the condition of making choices is irrational *[Irrationality premise]

The suicide choice is irrational [from 4,5] Kant Focus: The Irrationality Premise Example: slavery and freedom (J.S.Mill On Liberty) Counter-examples: 1.

2. Choice to end choices Sovereign Texas and USA Structure of real contradictions? We had to destroy the village to save it, lying promises Kant Stewardship Argument 1. 2.

3. 4. 5. One has the authority to dispose only of that which is ones own Ones embodied life is not ones own *[Stewardship premise] One has no authority to dispose of ones embodied life [from 1,2] Suicide disposes of ones embodied life One has no authority to commit suicide [from 3,4] Kant

Focus: The Stewardship Premise Reasons for accepting this premise? Humes Objection: If my life be not my own, it were criminal for me to put it in danger, as well as dispose of it: Nor could one man deserve the appellation of Hero, whom glory or friendship transports into the greatest dangers, and another merit the reproach of Wretch or Miscreant, who puts period to his

life, from the same or like motives [Of Suicide] Humes Objection In logical form: 1. 2. 3. 4. If ones life is not ones own, then one has no authority to dispose of ones life or put it at risk

If one has no authority to put ones life at risk, then heroic action is not permissible Heroic action is permissible Therefore, ones life is ones own Kants Reply We must draw a distinction between a suicide and a victim of fate[w]hat constitutes suicide is the intention to destroy oneself (389) You are a victim of fate if, had you been

given another option, you would have taken it. Example: soldier throwing himself on live grenade Doctrine of Double Effect Sometimes it is permissible to bring about as a merely foreseen side effect a harmful event that it would be impermissible to bring about intentionally Stanford Encyclopedia of Philosophy

Foresee / Intend (the consequences of an action) Aquinas: Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention. Accordingly, the act of selfdefense may have two effects: one, the saving of one's life; the other, the slaying of the aggressor. Stanford Encyclopedia of Philosophy Kants Reply (continued)

Recall: Suicide is the intentional termination of ones own life What constitutes intent? For Kant, intent includes the final objective of the act Soldier/grenade example So the final objective of the soldier is not to kill himself therefore, for Kant, the soldier does not have the (real) intent to die and his death is not a case of suicide and his selfsacrifice is morally permissible because it is

consistent with a respect for persons Brandts Pilot Case Brandts Pilot Case Brandt Option 1: stay in the plane, bring it down where it will do little damage - at the cost of certain death for himself Option 2: bail out of the plane, let it fall

where it will (very possibly killing a good number of people) - he survives Option 1 looks like it is suicide AND morally permissible How would Kant respond? Intention

Kant: this is not an act of suicide, but rather of self-sacrifice Why? Intention Brandt disagrees with Kants interpretation of intention. In ordinary language, the soldier who throws himself on the grenade or the pilot who dies to save innocent lives on the ground appear to intend their death. They are 100% sure they will die if they perform the action, and they knowingly choose to do so when other options are available. That they might have preferred to choose other actions is beside the point. Understanding Brandt

Why does Brandt have this account of intention? Recall that Brandt, as a Utilitarian, is a consequentialist. Doctrine of double effect and consequentialism Brandt 3 Common Arguments Against Suicide 1.

Theological Arguments 2. Natural Law Arguments 3. Social Harm Arguments 1. Theological Arguments A. St. Augustine, 6th Commandment

Modern Messages New Orleans 1998 Brandts Objections God prohibits suicide and we are bound by divine command Objection 1: arbitrary exegesis (392) Objection 2: If there is not some

consideration which shows on the merits of the case that suicide is morally wrong, God had no business prohibiting it Brandt & Euthyphro The central question is: "Is the pious loved by the gods because it is pious, or is it pious because it is loved by the gods? (Euthyphro, 10) So.. Is suicide bad because God forbids it? Or does God forbid suicide because it is bad?

Reasons for doubting the former option Brandt (and Kant!) believes the latter therefore we can access the reasons why it is bad and analyze them 2. Natural Law Argument St. Thomas (Aquinas):

Wherefore suicide is contrary to the inclination of nature[it] is always a mortal sin. (393) Brandts Objections Objection 1: Humans are not always morally bound to do what they have natural inclination to do (Natural/Moral come apart)

Examples: Chastity Violence/Aggression? Adultery? Addiction? Brandts Objections Objection 2: Some people do have a strong natural inclination to die

It is as natural for a human being to dislike, and to take steps to avoid, say, great pain, as it is to cling to life (393) 3. Social Harm Arguments Aristotle and others Suicide does harm to other persons,

or to society at large (393) Harm to the community/society from the loss of one person Think of family members, friends, colleagues Brandts Objection (From Hume)

Were not all Freud But surely there have been many suicides whose demise was not a noticeable loss to society; an honest man could only say that in some instances society was better off without them (394) Sometimes suicide does harm others, but sometimes it does not. Absolute prohibition is unwarranted. Example: suicide of terminally ill family not harmed (perhaps even benefited) Brandts Conclusions

Absolute prohibition on suicide is unjustified (even absurd) - there are some instances of morally justifiable suicide Some moral obligation to avoid suicide (which may be overridden) could be justified by Utilitarian calculus IF it is the case that a general prohibition on suicide would maximize utility THEN Mould the conceptual and motivational structure of persons so that they avoid suicide (feelings of guilt,

disapproval) Prevents many fit of passion suicides (anger, jealousy) but allows for deliberation which would allow those persons whose welfare is best served by suicide to proceed Rationality and Suicide

A person contemplating suicide chooses between future world-courses Choose the best/most rational world course by asking what a person would choose with all information taken into account Time indifference allow for desire/preference changes in the future Acknowledged uncertainty, but all life choices are based on probabilities anyway Clear beyond a reasonable doubt Depression and Rationality

Rational weighing of future life-courses (judgment) may be insidiously influenced by depression Also goal-gradient phenomenon (difficulty with time indifference) Brandt is concerned about these influences Considers the role of other persons in dealing

with these problems Brandt and the Role of Other Persons What is the moral obligation of other persons toward those who are contemplating suicide? (397) If there is such an obligation, it would be an instance of the more general obligation to render aid to those in serious distress, at least when this can be done at no great cost

to ones self (397) Moral Obligations to Others The Pond Case Thought experiment to motivate the principle child in the ornamental pond Obligations to Others

Peter Singers comparable moral significance principle: If it is in our power to prevent something very bad from happening without thereby sacrificing anything of comparable moral significance, we ought to do it." (Practical Ethics, 277) Implications for Brandt Brandt easily gets his moral obligations to assist those in distress from this general principle Assistance determining rationality of suicide Assistance in getting care if not rational Assistance in suicide if rational

There are also broad social implications of this moral principle Broad Implications Implications - Poverty Relative poverty when people are poor relative to the wealth of others Absolute poverty poverty by any standard

the lack of sufficient income in cash or kind to meet the most basic needs for food, clothing and shelter (Singer, 220) = 23% of the worlds population Approx. 400 million people lack the calories, protein, vitamins and minerals to sustain their bodies and minds in a healthy state

14 million children under five die each year from the combined effects of malnutrition and infection The rate of death from hunger-related diseases is equivalent to approximately 300 jumbo jet crashes per DAY with no survivors (and half the passengers are children) Death and disease aside, the quality of life for those who survive is very low (miserable) inadequate food, shelter, clothing, sanitation, health services and education Rich/Poor Gap and Moral Obligations to Others Wealthiest 1/5th of the population controls 85% of the global income

Poorest 1/5th of the population controls 1.4% of the global income Britains richest 10 people have as much wealth as 23 countries with over 174 million people Broad Implications of the Obligation to Assist Logical Structure:

1. If we can prevent something bad without sacrificing anything of comparable [moral] significance, we ought to do it [principle] Absolute poverty is bad There is some absolute poverty we can prevent without sacrificing anything of comparable moral significance We ought to prevent some absolute poverty [from 1,2,3] 2. 3. 4.

Discussion Problems with the argument? Does this conflict with any other moral intuitions we have? (Use reflective equilibrium) The motorcycle accident vs. the envelope (Peter Unger) Are we (the absolutely affluent)

moral? Summary Suicide the intentional termination of ones own life 1. 2. 3. 4. 5. 6. 7. Suicide definition Kants arguments against suicide Brandts pilot case

Brandts rebuttal of common arguments against suicide Brandts arguments against absolute prohibition on suicide Moral obligations of others Implications of a general principle of moral obligations to others Next Class Morality of suicide as it arises in the medical context. Special case: Euthanasia

And next Monday: Physician-Assisted Suicide Contact Prof. Kirstin Borgerson Room 359S Munk Centre for International Studies Office Hours: Tuesday 3-5pm Course Website:

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