Bioethics

1. Bioethics Summer 2005 University of Toronto Prof. Kirstin Borgerson kirstin@chass.utoronto.ca Room 359S Munk Centre Office Hours: Tuesday 3-5pm and by appointment

2. Review/Preview • Course specifics: • Website and notes: www.chass.utoronto.ca/~kirstin • 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

3. Theories Principles Specific Cases Methodology: reflective equilibrium

4. Suicide • Lecture 1 Outline: • Suicide – definition • Kant’s arguments against suicide • Brandt’s pilot case • Brandt’s rebuttal of common arguments against suicide • Brandt’s arguments against absolute prohibition on suicide • Moral obligations of others • Implications of a general principle of moral obligations to others

5. Suicide “The intentional termination of one’s 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?

6. Kant/Brandt • Deontological position (Kant): “suicide is in no circumstances permissible” (388) • Utilitarian/Consequentialist position (Brandt): “suicide is sometimes morally acceptable” (391)

7. 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 self-contradictory” (388)

8. Kant • Irrationality Argument (Self-contradiction) • One’s embodied life is the condition of any choice one makes • Suicide destroys one’s embodied life • One’s embodied life is the condition of the suicide choice [from 1] • Suicide destroys the condition of one’s 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]

9. Kant • Focus: The Irrationality Premise • Example: slavery and freedom (J.S.Mill On Liberty) • Counter-examples: • Choice to end choices – Sovereign Texas and USA • Structure of real contradictions? – “We had to destroy the village to save it”, lying promises

10. Kant • Stewardship Argument • One has the authority to dispose only of that which is one’s own • One’s embodied life is not one’s own *[Stewardship premise] • One has no authority to dispose of one’s embodied life [from 1,2] • Suicide disposes of one’s embodied life • One has no authority to commit suicide [from 3,4]

11. Kant • Focus: The Stewardship Premise • Reasons for accepting this premise? • Hume’s 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’]

12. Hume’s Objection • In logical form: • If one’s life is not one’s own, then one has no authority to dispose of one’s life or put it at risk • If one has no authority to put one’s life at risk, then heroic action is not permissible • Heroic action is permissible • Therefore, one’s life is one’s own

13. Kant’s 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

14. 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 self-defense may have two effects: one, the saving of one's life; the other, the slaying of the aggressor.” – Stanford Encyclopedia of Philosophy

15. Kant’s Reply (continued) • Recall: Suicide is “the intentional termination of one’s 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 self-sacrifice is morally permissible because it is consistent with a respect for persons

16. Brandt’s Pilot Case

17. Brandt’s Pilot Case

18. 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?

19. Intention • Kant: this is not an act of suicide, but rather of self-sacrifice • Why? Intention • Brandt disagrees with Kant’s 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.

20. 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

21. Brandt – 3 Common Arguments Against Suicide • Theological Arguments • Natural Law Arguments • Social Harm Arguments

22. 1. Theological Arguments • A. St. Augustine, 6th Commandment

23. Modern Messages – New Orleans 1998

24. Brandt’s 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”

25. 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

26. 2. Natural Law Argument • St. Thomas (Aquinas): • “Wherefore suicide is contrary to the inclination of nature…[it] is always a mortal sin.” (393)

27. Brandt’s 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?

28. Brandt’s 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)

29. 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…

30. Brandt’s Objection • (From Hume) • We’re 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)

31. Brandt’s 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

32. 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’

33. 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

34. 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 one’s self” (397)

35. Moral Obligations to Others – The Pond Case • Thought experiment to motivate the principle – child in the ornamental pond

37. Obligations to Others • Peter Singer’s ‘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)

38. 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

39. Broad Implications

40. 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 world’s 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

41. 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 • Britain’s richest 10 people have as much wealth as 23 countries with over 174 million people

42. Broad Implications of the Obligation to Assist • Logical Structure: • 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]

43. 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?

44. Summary Suicide – “the intentional termination of one’s own life” • Suicide – definition • Kant’s arguments against suicide • Brandt’s pilot case • Brandt’s rebuttal of common arguments against suicide • Brandt’s arguments against absolute prohibition on suicide • Moral obligations of others • Implications of a general principle of moral obligations to others

45. Next Class • Morality of suicide as it arises in the medical context. Special case: • Euthanasia • And next Monday: Physician-Assisted Suicide

46. Contact Prof. Kirstin Borgerson Room 359S Munk Centre for International Studies Office Hours: Tuesday 3-5pm Course Website: www.chass.utoronto.ca/~kirstin