Since I mention this in my post responding to Al H’s objections comment about assisted dying, it seems worthwhile copying it here. In their book Easeful Death: Is there a Case for Assisted Dying? (Oxford University Press, 2008), Baroness Mary Warnock, a philosopher, and Dr. Elisabeth MacDonald, a cancer specialist and expert in medical law, write as follows about the argument from vulnerability:
So what are the abuses that the Australian, Chris Wake ‘knew’ would follow a change in the law? What is said to lie at the bottom of the slope varies according to the person or the group of people who deploy the argument.
One of the fears most commonly expressed is that, if assisted death were an option, patients in the last stages of their illness might have pressure put on them to ask for it, when it was not what they really wanted. It is not difficult to imagine feeling that one’s children were getting impatient either for their inheritance or simply for
relief from the burden of care, and that one had not so much a right to ask for death, as a duty to do so, now that it was lawful to provide it. There undoubtedly exist predatory or simply exhausted relatives. But it is insulting to those who ask to be allowed to die to assume that they are incapable of making a genuinely independent choice, free from influence. (Indeed, there are people so determined to confound their children, if they see them as vultures hovering over a hoped-for corpse, that their will to spite them by staying alive may outweigh their wish to escape their own pain).In any case, to ask for death for the sake of one’s children or other close relatives can be seen as an admirable thing to do, not in the least indicative of undue pressure, or pressure of any kind. Other kinds of altruism are generally thought worthy of praise. Why should one not admire this final altruistic act? And it would not be wholly altruistic: the desire to avoid squandering resources, or being a burden is combined, in the cases we are considering, with a sense that prolonging life is both futile and painful. It is idle to try to separate these motives. Part of what makes a patient’s suffering intolerable may be the sense that he is ruining other people’s lives. If he feels this keenly, and asks to be allowed to die, he is not a vulnerable victim, but a rational moral agent. [83]
This seems to me a perfectly reasonable counter to arguments (such a Al H’s) which think that “vulnerable” people would be endangered by assisted dying laws. The claim that we should not accept the request for assisted dying from someone suffering intolerably, because some people “might” be influenced to request assisted dying when they do not really want it, is clearly intolerably patronising and cruel. It patronises the person who is asking for assisted dying who genuinely does not want to be a burden of their family, and it is cruel to those who are suffering intolerably. Additionally, as Warnock and Macdonald point out, it is difficult to separate these motives, which may often be combined. The trouble is that the argument is fielded only because religious arguments will not fly in this context, so that those opposed to assisted dying will use practically any expedient to deny the rights of those who are suffering and want help to die. Additionally, there are ways of ensuring that people are not being placed under pressure to ask for assisted dying. They can be interviewed by people who can make sure that the decision is one thoughtfully and autonomously made.
It is important to note also (once again) that the very same concerns, if the concerns have any legitimacy at all, arise in cases where requests are made to withdraw life support and other life-prolonging measures, where no question as to legality exists. It is simply special pleading to suppose that these issues arise, if they arise at all, only in cases where positive assistance in dying is requested. Christians really need to make an effort to be consistent, at the very least.
The slippery slope argument appears to be the only thing the foes of assisted dying have in their arsenal.
“Oh noes. If we let people in terminal agony end their misery, then all of the nursing homes will be emptied and little Jimmy the ‘retard’ will be killed, too! DEATH PANELS!!eleventy11!!”
Kevin: As someone who has extensively studied and even taught medical ethics, I can assure you that… basically, you’re right. Aside from insistent and oft-repeated declarations that life is of sacred and inviolable absolute value — which declarations pay no attention at all to those properties and activities which actually give life its value — all assisted suicide opponents have is variations on the slippery slope fallacy. Even your sarcastic “Oh noes!” mockery is well warranted: It gets rather tiresome after a while, reading the exact same flawed and thoroughly refuted arguments over and over — so much so that one is reminded of creationists.
*sigh*
As I’ve commented here before, IF these arguments apply to assisted dying, then they clearly also apply to other important life situations in which ‘vulnerable’ people may be influenced by claims made on them by self-interested others. Whether to take a life partner, and who and when? What jobs. promotions or transfers to apply for ? What job to take? Where to live? Whether to buy a house or rent? Whether to have children, and if so when and how many? If people aren’t capable of making rational independent decisions about how and when to die, then clearly they’re not capable of making rational independent decisions about these other important issues either, and the right to do so should be taken away from them.
Are the opponents of assisted dying prepared to argue against ‘assisted’ marriage, ‘assisted’ childbearing and ‘assisted’ house-buying too?
I apologize for what will be a scattershot comment, but there are a lot of issues here that are related and I don’t want to spread that out across multiple comments, so, starting with Kevin …
This seems to be a very unfair characterization, seeing as even on this site we’ve seen that the people are much more sympathetic to allowing assisted suicide in cases where the patient is going to die from their condition and it’s either now or a year from now with a lot of suffering in between. There are potentially a lot of issues with even that, but to extrapolate from that to this end seems a bit strong. Additionally, you characterize it as “letting them end their misery”, but there’s a distinction between them committing suicide — which most of the people arguing against this would likely find tragic but probably wouldn’t make illegal — and putting it in law that they can actually be killed if they ask for it. There are a LOT of moral issues around that.
So, Eric, when you make this comparison:
It’s a bit unfair because the terminal cases are the ones that are directly comparable to this, and those cases are certainly seen as being more reasonable/debatable than the non-terminal cases that most arguments do rely on. The second issue is that it’s not unreasonable to say that there’s a difference between deciding not to artificially prolong someone’s life and to taking a direct action to end it. For consequentialists, there isn’t, but for intentionalists there is … and legally intentions are taken into account, and there is a lot of moral work that does take that into account (I, personally, am a staunch intentionalist). We can also see that, at least right now, if those measures were withdrawn and the person was able to survive on their own, they’d still be entitled to reasonable additional support, so it isn’t a case of “They’re better off dead”.
Additionally, in those cases the consent is either given long ahead and so isn’t as prone to those sorts of pressures, or the person is unconscious and has had the medical professionals say that they will be unlikely to ever recover. Thus, in those cases the “burden” pressures are less relevant. If it was believed, for example, that the person would recover but be, say, paralyzed, it seems unlikely that it would be allowed unless that itself was directly specified.
Moving on to corio37:
We can see a few differences here. The first is that the condition they’re in has far more of an impact than most of those cases. The post a long time ago about how they are likely to be depressed is valid; these are extreme conditions, and we’re not known for making great decisions while in extreme conditions. Add in that there may be massive pressure due to the burden, and it’s a stronger case. The second is that it’s irreversible; there’s no way to salvage this if they make a mistake. That suggests that they should be at their peak decision-making capacity, and they clearly aren’t.
Back to Eric:
If someone looks at their condition and thinks that their life would be worth living, but the only issue is that they feel that they will be a burden to their family, then my immediate response would be that instead of legalizing and legitimizing their being assisted to die in those cases we should legally and socially make it so that that is seen as not being their concern. I don’t think it legitimate to decide that while you think you would have a fulfilling life, it might burden others so you should just die to get out of the way, and see no reason why it should be. But, of course, that’s debatable, but it’s certainly not obvious that they, in fact, should not be so patronized. And this leads to a bit of a contradiction with this:
And so if in the opinion of this interviewer the pressure is too much, they will, I presume, not allow it? Even if the person themselves doesn’t think that the pressure contributed that much to their decision. So much for not patronizing them, as you still end up deciding for them. At least if they don’t allow it at all, it isn’t making a judgement on their ACTUAL state, which is what’s done here.
As usual, I have to agree with all of you. Although I came to this site initially because of my wife Isobel’s terminal cancer, these discussions have help me formulate my own views more clearly. The bottom line for me is that it is my right to make my own decisions about my own life. I have two sons whom I love dearly, and I certainly don’t intend to waste any part of their lives by having them feeling obligated to care for me, if I reach a stage where I can’t care for myself. In these circumstances, it would upset me greatly to see what little money I may have to leave to them, frittered away needlessly on personal nursing care. For me, it will be a perfectly rational choice, and I think I’ll know when to make it.
My only concern is that the gradual onset of dementia may rob me of the right to make that decision, since by definition I will have to be rational to make it. I already have an Advance Directive to cover situations where I am unable to express my wishes due to being unconscious or “locked in”, but so far I’ve been unable to come up with a satisfactory form of words that would allow someone to assist my death once I have clinical dementia. Having had both parents suffer from dementia for over ten years before dying, I would certainly not wish that on my sons. I guess it will remain impossible to cover all the bases.
My main point remains that choosing to die for the sake of one’s children’s quality of life seems perfectly rational to me.
Verbosestoic:
Yes it is. Read the literature. When it comes right down to it, you cannot separate intentions in the way that your so-called “intentionalists” try to do it. If you know that something will happen if you do X, intending A — say B — then you are as responsible for B as you are for A. It’s that simple, no matter how much you waffle about it. Even Aquinas recognised this.
Secondly:
Which is exactly what I said! As I say, quite clearly, in “Christian Temporising over assisted dying”:
So, I’m not sure I get the point of either of your criticisms.
As for having someone else provide some assurance that the decision is autonomously and freely made. No, the person who gets to decide, in the end, is the one asking for assisted dying. That is one area where the Dutch law is deficient, for it allows individuals’ reasonable decisions to be overridden by “expert” witnesses. However, allowing for the intervention of someone from outside the “domestic” situation, to assess whether or not the decision is being made autonomously, is reasonable and wise. But having assessed the situation, and offered alternatives, if the alternatives are not weighty enough to change the person’s decision, there is no reason not to permit assisted dying. Giving too much weight to a third person’s view is simply opening the door to precisely the kind of patronising that you speak of, and which I do not support. But, for those who fear that people may come under undue influence, it is reasonable to provide at least some check on the process to allay those fears.
Haggis, in response to your point. No, it is not possible at the present time, given the proposals for assisted dying that are being considered, to make provision for cases of dementia. If active euthanasia, and not simply assisted “suicide”, were being proposed, there is no reason why advance directives should not provide some provisions for that, though even here thoughtful people are concerned about issues of personal identity. If I draft an advanced directive that says that, in the event of future dementia, I want to be ushered painlessly out of life, and, when the time comes, though I have no memory, and my mental abilities are minimal, but I appear to be happy and enjoying life, does that advanced directive still hold? For am I now the person who wrote that directive? I say this is a question that has been raised, and I do not know how to answer it. For a person who does not remember having made this directive, and would, perhaps, if it were put to him/her in his/her present state, object to being killed, seems to be a different person for purposes of assisted dying provisions. Other than that, and having worked with people whose minds have quite disappeared, I would not want to be in that state, but then, would I be that “new” person who is then in the body that I now consider “mine”? For the transition from being the person I am, through being the limited, yet “happy” person, in a demented state, to being, in some sense, a non-person, is a gradual process, and this raises issues that are not raised by cases in which continuity of personhood (that is, a unified narrative history) is not in question. Having said that, I agree entirely with you, that not wanting to be a burden is a perfectly rational desire, and to act on it would also be rational. However, making sure that one is regarded as a burden, notwithstanding one’s own feelings on the matter, would also be important. For example, Elizabeth did not want to die, yet death was the only way out of the suffering she endured day by day. Had she thought that she should go because she was a burden upon me — and this was something I had to make sure she did not feel — I would have tried very hard to convince her that having her with me was pure joy, and not a burden at all, so that, if she wanted to act in accordance with my wishes, she should not go, because I wanted her to stay, and did in fact make that request. She, however, said, with great determination, “I’m sorry. I simply can’t stay.”
@verbose stoic: “these are extreme conditions, and we’re not known for making great decisions while in extreme conditions.”
And being about to propose isn’t? Being about to put a down-payment on a house which will absorb two-thirds of your income for the next decade isn’t? Deciding to disrupt your life irrevocably and forever by having a child isn’t? Again, if you think people can’t be relied on to make decisions about their own death — having plenty of time to consider it and weigh the options — I don’t see how you can possibly trust them to make rational decisions about what to do when their pregnancy test comes back positive. Perhaps we should just surrender all our important decisions to the benificent offices of the Church; I’m sure they’d have no doubt about their ability to handle them.
Eric,
I think you’re confused about what my claim is. I see you as saying that the case where you take someone off life support and where you assist their dying are both morally equivalent in that they have the exact same moral status in all relevant features, and so arguing from that equivalence that if it is okay to take someone off life support then it also must be okay to assist their dying. My contention is that you can only do that using a very strong and simplistic consequentialist argument, arguing that because at the end of it all both are dead then the cases are identical. Under an intentionalist model, the intentions are different and so they are not morally identical, and so not morally equivalent in that strong sense. This does not mean that I am saying that therefore taking someone off life support is morally right and assisted dying is morally wrong, but simply means that I’m saying that you cannot tie their moral truth values together so easily. You need a better argument … or to get everyone else to accept that very shallow consequentialist interpretation, that in and of itself has major issues.
In that light, I find your comments about my reading the literature and waffling to be out of place.
Also, if you think that someone who thinks that they could have a decent life even in their condition but wants to choose assisted dying to avoid being a burden is making a mistake, then I fail to see what your comment about the comments being patronizing to those who legitimately do not wish to be a burden of their family is aimed at, other than perhaps a claim that even if they feel that pressure they should still be intelligent enough — and considered such — to make the right decision to not choose assisted dying in those cases.
So, consider this case: the third person assessment is that the person was clearly unduly pressured into the decision, and because of that pressure is unwilling and unable to consider that that is their only reason (they’re making an error). If you don’t give them the ability to say that the person is not making their decision for valid reasons — ie that they are only making the decision they are making due to that pressure — then you are allowing precisely the case that you are saying is an invalid fear. And if you give that ability, then you run into the trumping of their autonomy that you yourself wish to avoid. I don’t see how you can have it both ways.
corio37,
I am talking about the conditions they are under, not the decisions they are making. In general, people aren’t in a particularly irrational condition when they are deciding to buy a house or have children, nor under they generally under potentially undue pressure. And when they are, we say that they should take their time with the decision and that it’s a mistake for them to decide based on those conditions. As for marriage, love COULD be seen as being a case of that sort of condition, but that’s why it’s recommended to not rush into that either, and let the hormones calm down.
Someone who has had a sudden change in their condition so that their entire lifestyle will change and is certainly under physical as well as mental strain is in a different condition, and is definitely in a state of mind that means that they are less able to look ahead positively to the future and are likely more susceptible to pressure. As I also said, it’s a decision that you cannot change. That makes it different than any of your examples.
Oh, and please stop making insinuations that my view is religious. You should know better than that, and it’s getting really annoying.
Verbosestoic. Of course, the value of your continual refinement of argumentation is not pointless, but it is a bit precious at times. Take this:
Now, I am not going to repeat the arguments that are out there in the literature, and you may consult them as you wish, but there is in fact no reason for accepting what you call the “intentionalist model.” It is not possible to separate intentions in the way that the principle of double effect, in many of its iterations, seems to demand. In the end it comes down to a different way of describing the act, and can, in fact, be used to justify practically anything. If my intention in Xing was A, and not B, where Xing to achieve A is a benign intention, and Xing with the intention to achieve B is a not so benign intention, then my Xing in this case was morally acceptable, even though bringing about B might be thought to be a disastrous consequence. Just because the intentions are different does not morally excuse the outcome B. The point is that no one seems to think that the same kinds of problem exist in the withdrawal of life-support that exist with the act of helping someone die, although both cases may reasonably be seen (in many cases) as doing precisely that. One is legal in Canada, the other is not, even though both achieve the same end, and, very often, withdrawal of treatment achieves the same end with much more serious and unnecessary suffering. I cannot do more that sketch the argument. You must go to the sources to answer the question. Begin, say, with Helga Kuhse’s The Sanctity of Life Principle in Medicine, or Jocelyn Downie’s Dying Justice. There are a lot of things written by Margaret Pabst Battin, too numerous to list, but lots on this kind of thing.
As to people making errors in judgement. In the end, we allow people to make them all the time, often with disastrous consequences. I got married to someone, and it was a big mistake, as I realized early on. We may not want to allow someone to make the decision to bring life to an end, and may want to adopt a patronizing stand toward them, because we believe they are making an error of judgement. Yet in what sense would it be right to establish a decision procedure which allowed someone else to make the final judgement about a course of action, despite the fact that the deciding person is convinced that no such error is being made? The point, however, is simply this. Some people say that assisted dying laws will put the vulnerable at risk. I suggest that we can have a decision procedure which would require the intervention of a third person, unrelated to the situation, who can help make sure that the person is not making the decision under, say, the belief that they are a burden, despite the fact that they find life meaningful and worthwhile. The person nevertheless continues to insist that they are not making the decision for that reason, even though the third party believes that they are, and that they are going to make an error in judgement. Well, so what? We have done what we can to make sure that errors in judgement are not made. We cannot ensure that no one makes a mistake in judgement. The fear is still unjustified, since we have at least a screening procedure which will probably catch the truly vulnerable. The thing is, though, that so far there is no basis for the fear in the first place, given the studies that have been conducted, and, in any event, we allow people to make important decisions all the time which may have disastrous consequences for them.
Regarding Corio’s suggestion that your view is religious, which you find so annoying. But you do seem to suggest, not that your view is religious, but that your view somehow reflects “natural law”, a very relevant Stoic belief which you seem to accept. Of course, the Stoic belief was in fact in essence religious, and it is hard, I think, to separate natural law theories from the idea that there is an intelligence — a Logos — behind the structure of the universe and the human place in it. If that is not your view, as it has always seemed to me that it is, it would be helpful if you would make the foundation of your moral claims clear.
Eric,
Well, I had thought about getting into the intentionalist/consequentialist debate, but put it aside to talk more about the specific issue. But here, it looks like that’s what we have to talk about.
So, what we are talking about, in general, are cases where the direct action taken is to produce A, but as part of that B will also occur. It turns out that both consquentialism and intentionalism have problems with these, depending on the knowledge of the person making the decision. Consequentialism has problems with cases where B being produced is accidental and they had no way of knowing that it would happen. Under consequentialism, they’d be held morally responsible and have done something morally wrong because of a consequence that they had no reasonable way of knowing would occur. That just seems problematic. Also, in cases where B occurs due to circumstances beyond their control and that they could not have predicted, consequentialism still holds them morally responsible for B’s occurrence. But surely if they could not have known that B would occur and could have done nothing to prevent it occurring they ought not be held morally responsible for it, at the risk of creating a morality that it is impossible to actually follow.
But you are correct that intentionalism has a problem when your main goal is to produce A but you know that B will occur. Because intentionalism answers the accidental case with “You didn’t intend B, so you are not morally responsible for B”, there’s a risk of someone taking advantage of that to consider B as nothing more than a subsidiary or, worse, not bothering to look for what the consequences would be because if they don’t know what they are, they can’t intend it and so are morally blameless.
However, for intentionalism we can correct for these by rejecting a simple intentionalism and adding a bit more to it. So we can say that if you can achieve A without B occurring, but you choose to act so that you get A with B also occurring, you therefore also intend B to occur, and so are morally responsible for it, while still appealing only to intentions. Also, for those cases where someone deliberately avoids looking to alternatives or looking to see what will reasonably happen if they take that action we can easily claim that that was part of their intention, and so hold them morally responsible for their negligence is doing that. So it’s easy to solve that problem by refining intentions.
I don’t see the problem consequentialism has being solved by anything except by importing intentions into that view, which would make it not consequentialist anymore.
Thus, if the choices are consequentialism or intentionalism I think we have very good reasons to think that some form of intentionalism is true, unless you want to adopt the position that someone ought to be held morally responsible for consequences beyond their control and that they could not have predicted in advance.
So, now, back to the original discussion. The difference, I submit, is the difference in taking an action to stop prolonging the person’s life and in directly taking it. So, if you argued that their suffering is bad, in the first case it is indeed only your actions that prolong that suffering, but in the second case that suffering is just happening and you are not taking a direct action to end it (and are taking no action at all). Yes, one can be held morally responsible for inaction which applies to both cases, but from that sort of analysis we can see that there is a difference there, and one that might make a major difference to their moral evaluations. It’s only a very shallow consequentialist interpretation, as far as I can see, that holds them to be equivalent. In theory, you could make an intentionalist argument for them being the same by appealing to an intention to not prolong their suffering, but that’s debatable in the first case as well. And then you’d still have to note my comments about how terminal cases ARE more comparable and so people are, as you yourself have noted, more sympathetic to it (likely because of that “prolonging a life” thing).
On decision-making, my main point is that you are not assuaging the concerns of those who think it will put the vulnerable at risk unless you are willing to say that if it is determined that they are making an invalid decision they are stopped from doing so. And that would violate your comments on autonomy, and I still say you cannot have both.
On religion, corio37 said this to me:
Re-reading it, it isn’t as strong as it struck me originally, but what do your comments on the Stoics — which I think are reaching a bit — do to defend corio37′s association of my view with the Church, and letting the Church make all the important decisions? I said nothing at all like that, and my view is not tied to that, so why bring it up?
As for my own moral basis, I would suggest that I don’t need to mention it and no one needs to really know it unless it is relevant … and when it is relevant, I mention it. Even here, I do explain and highlight intentionalist views from the start, because it is relevant to the discussion. You don’t need to know anything more, and so I would suggest that instead of guessing at other underlying moral concerns sticking to what it being said would be best.
That being said, if you’re curious, a statement of my current view and basis is here: http://verbosestoic.wordpress.com/2012/08/03/virtue-and-vice-ends-and-means/
Verbosestoic. I have to say that I cannot for the life of me see the point of what you are arguing in your last comment. It seems to me a desperate attempt to make distinctions where there are none to be made, and I wonder what the point of it is. So far as the concerns of those who fear that there are slippery slopes in the vicinity, I don’t see how you have shown that these fears are justified. Some people will doubtless go on expressing those fears, justified or not, because that is the only secular argument they have against assisted dying, and factitious or not, they are stuck with it. But I think the distinctions you are trying to make between intentions and consequences here are almost as far-fetched as that. I have very little to add to what I have said, and I do not think engaging what you have said would be particularly fruitful.
Eric,
I admit that I’m confused by your response. A big part of it, as I pointed out, was posted in order to defend against attacks on intentionalism in general, and I cannot imagine that you don’t see a distinction between intentionalism and consequentialism as moral approaches. So, about the only thing you could be saying is that I have not established that there is a really meaningful difference between disconnecting someone’s life support and engaging in assisted suicide. I will concede that, but will note that my original comment was basically aimed at showing nothing more than that you haven’t established that they are the same either. They are clearly different, and while you may believe that they are equivalent I would note that beyond “read the literature” you haven’t actually argued for it.
As for the fears being justified, I do not need to argue for that, because you conceded that their fears are at least not unreasonable by introducing your third party analysis to try to avoid the problems they cite. My whole reply is that you cannot both claim that autonomy is paramount and that you’ve fixed those problems, since if you give the ability for the third person to overturn the decision you trump autonomy, and if you don’t then you allow for cases where it is objectively clear that it is a case like the one they are fearing to be acted upon, which means that what they say will happen still can happen. You can argue that it isn’t going to be common or even that autonomy still trumps that case, but I see your analysis point as an attempt to provide a compromise that I don’t see as a practical compromise at all between the two views, and thus suggest that you pick one as your ultimate goal and perhaps add in some practicalities to make things better while acknowledging that the other side’s objections and fears will not be answered.
Just a couple remarks in response. You say:
I’m not sure what you mean by speaking about “intentionalism”. The idea behind the principle of double effect (PDE), which is what we were discussing here, is that, if I have an intention to one thing A, knowing that it may also have the effect B, then my intending A and not B, excuses me for causing B. You are, after all, responsible for all the follow on effects of your actions, even if you did not think of some of them. If you act carelessly, and without thinking of all the ramifications of your actions, then you will certainly be held responsible for consequences you should have known would happen. I don’t think it makes much sense to suppose that you can sort consequences into those intended and those not intended in this fashion, and neither do many others who analyse the PDE.
That’s the first point. The second point arises from you saying the following:
No, I am not saying their fears are justified, because some sort of third party assessment has always been a feature of assisted dying proposals, but people continue to repeat their slippery slope fears notwithstanding. It is unreasonable to have such fears since (a) assisted dying proposals have at least some safety precautions built in, but (b), even if people do decide to receive assisted dying in situations that others consider disastrous, they are the considered decisions of autonomous persons, and we should let people make their own decisions regarding when to die, provided we have at least set our minds at ease about them being vulnerable and liable to pressure, that is, even if we think that their so deciding is a foolish decision. I speak from experience here. Lots of people suggested that Elizabeth was vulnerable, because depressed, and that I was responsible, because I allowed her to make a decision which brought about a harm to herself. That was not Elizabeth’s view, and I acted as I did, by accompanying her to Switzerland, because that was her irrevocable decision. I would have been happier if she could have stayed longer, but she said she could not do that. But even is she was vulnerable, being “vulnerable” is not to be non-autonomous, as so many people suggest, and as religious fear mongers have claimed, getting at least a part of the so-called “vulnerable” constituency to agree with them. Elizabeth would have quite contemptuously rejected their claims about her vulnerability, and she would, in my opinion, have been right to do so. Nor do I think any third party should have had the right to say, “No, sorry, you don’t qualify.” It was conditional, however, on Dignitas’s physician consultant, but no reasonable person could have said that Elizabeth’s future held anything but increasing disability, pain and distress, despite the claims of some (after I returned to Canada) to know better than she.
Eric,
I think something has gone off the rails here, because when you say this:
It ignores what I myself said about intentionalism:
So, yes, I understand that that is a problem. But both intentionalism and consequentialism have problems in the double effect case you describe, meaning roughly the case where you take an action intending A, but as part of that B will occur, which is not intended. The problem for consequentialism, as I pointed out, is in cases where you don’t know and couldn’t reasonably know that B would occur: consequentialism says that you are still responsible for B.
Roughly, intentionalism means that the morality of your actions is determined by your intentions, and consequentialism means that the morality of your actions is determined by the consequences (usually, the ones that actually happen).
Now, I DID reply to that problem for intentionalism:
With respect to the general case you cite, if there is no other option to achieve A, then we can indeed say in some sense that the intention is A and not B.
For the specific case, my argument is more than that. The intention to stop prolonging someone’s life is different than an intention to end their life to end their suffering. The acts are, in fact, completely different. The only argument I can see for holding them to be identical is, as I said, under a VERY strong and simplistic and shallow view of consequentialism that says “Well, at the end of it all they’re dead in both cases, so they’re identical”. This does not mean that they are not both right or wrong, or even that similar considerations will be used. All I’ve seen from you is that they are identical and that their moral value then must fall the same way in both cases, which I see no evidence or argument for (and I have enough to read as it is without reading more in the hopes of FINDING an argument [grin]).
The problem here is that you answer their fears in two ways that at least concede to them that their point is not unreasonable (I never said justified, BTW). a) says that you built in precautions to eliminate the problems, meaning that you concede that there could be pressure and the like but that you’ve mitigated it. They can, as I said, quite reasonably reply that without giving that third party assessment the ability to say “No” you haven’t solved the problem. b) says that even if this does happen, autonomy trumps it. This, again, explicitly concedes that what they fear might happen but that there is a more important principle that has to allow for that. Thus, in no way are you demonstrating that their fears are totally unjustified and not worthy of consideration, but are instead simply pointing out that the risk is sufficiently lot, and that it’s a risk we have to take. Both of those can be challenged.
My main reason for bringing this up is just a reflection of my normal frustration of people arguing that their opponents are just raising utterly baseless concerns when they aren’t baseless but the person thinks the issue has been addressed. Say that you think it’s been addressed or that we have to allow for that to happen instead of just saying that they don’t have a valid concern.
Dear Lord, man (Verbosetoic), you are complicating this unnecessarily, and, into the bargain, saying that I accept things which I do not accept. So let’s try this once again.
First of all, I do not understand the difference between intentionalism (is this a moral theory?) and consequentialism. (Consequentialism is not a specific moral theory, but characterises a class of moral theories, all of which hold consequences to be the decisive criteria in deciding the rights and wrongs of actions. Utilitarianism is the best known of the consequentialist theories, but straightforward hedonism might be another. And consequentialist theories can also be further subdivided in to Rule Consequentialist theories, etc.) We are responsible for all the consequences of our actions, though we may not, because we could not be aware of some of the consequences, be blameworthy on account of those consequences. Nonetheless, if they flow directly from our action, we are responsible, and in some cases a claim to ignorance would not be sufficient, for it might be said, that we ought to have known that that particular consequence would flow from our action on that occasion.
As to the matter of baseless concerns. When opponents of assisted dying raise the spectre of the fears of the vulnerable if assisted dying is legalised, I do not think, in general, it is true that these fears exist. Indeed, some disabled people have banded together and said, “We don’t want to be treated as marginal people who need to be babied. We are quite capable of making our own decisions. There is no basis for fear, and we object to be being used to oppose assisted dying.” I took note of, and then promptly forgot, the organisation that was recently formed for this purpose. So I do not acknowledge that these fears are either justified, or of great significance for the proponents of assisted dying. And if they are of such significance, the right that people have to stop treatment or to refuse treatment should raise the same concerns, and they don’t. So I did not concede that their concerns are not unreasonable. I only said that, though there is no basis for their concerns, their concerns being, in part at least, perhaps in large part, factitious, and deployed by opponents of assisted dying for political purposes, the checks that would in any case be applied to cases of assisted dying should allay them. And if they don’t that is not the problem for proponents of assisted dying. People are worried unreasonably about lots of things.
As to this claim:
I deny this. They are not completely different at all. For this I am not going to argue in detail, but you can find a refutation of the point in Helga Kuhse’s The Sanctity of Life Doctrine in Medicine: A Critique, and Jocelyn Downie, Dying Justice, and Beauchamp and Childress, Principles of Biomedical Ethics. I believe, if I remember aright, the Royal Society of Canada expert panel report on end of life decision making also discusses this. Anyway, there are lots of sources. You are quite entitled to go on believing otherwise, but I think you should address yourself to some of the literature at least.
Just to reiterate. I do not understand what you mean by intentionalism. I do not recognise it as a distinct moral theory, though intentions play a role in most moral theories. The doctrine of double effect depends upon the idea of intentions, and the possibility of distinguishing within acts of specific intentions, and then possibilities which in some sense lie outside those intentions. I do not think intentions can be parcelled out in this way. But you really must address yourself, not only to what I write, but to those moral philosophers whose work I cite. It is not good going round in circles like this.