Monday, April 11, 2005

Self-Sacrificial Euthanasia

Spring is here. The air is clear, the grass is suddenly too long, birds are singing. What better time to talk about death and dying?

I've never blogged about the Terri Schiavo affair, although I followed it with great interest. The areas involved -- the philosophy (and neurology) of mind, the morality of euthanasia -- are those in which I have almost everything to learn, and nothing to teach. This belated contribution is an effort to clarify my own thinking about a particular part of the issue.

I divide killing into five main types:

(1) A kills B for the sake of A. (murder; sometimes self-defense)
(2) A kills B for the sake of C. (some self-defense; war; capital punishment)
(3) A kills B for the sake of B. (euthanasia)
(4) A kills A for the sake of A. (suicide)
(5) A kills A for the sake of B. (sacrifice)

All of these main types admittedly give rise to a host of boundary cases, depending on how we parse the notions of "kill" and "for the sake of" in each individual case. Obviously the meaning of "for the sake of" in Type 1 will lead to a differentiation between Type 1a (murder), in which "for the sake of" means for gain, for revenge, out of hatred, and Type 1b, self-defense, in which "for the sake of" means "out of a legitimate motive of self-preservation." I take it that out of all these types, only Type 1a is expressly forbidden by the commandment "thou shalt not kill (murder)." (I should also say here that "kills" in the typology above is shorthand for any kind of death-causing, including passive kinds, such as letting someone expire, or refusing to rescue; or indirect kinds, such as directing another to kill, or withhold care; or in the case of Type 5, accepting death, or getting in harm's way, in the interest of another.)

Type 2 is also morally permissible or impermissible depending on the meaning given to "for the sake of" in individual cases. A war of aggression and a war of self-defense would have different moral standings. The varying positions taken on the war in Iraq, for instance, differ as one sees the motive being overall self-centered ("blood for oil") or overall altruistic ("freedom for Iraq"). And obviously a war will feature a mixture of all these types of killing, but by intention a "just" Type 2 will predominate.

Type 3 is the type most relevant to the Schiavo case. In the Schiavo case, the pro-death side hesitated between (a) parsing the feeding-tube withdrawal as a case of Type 3 killing (Terri would have wanted this; this was Michael Schiavo's position), or (b) Terri was already dead, having lost all higher brain function, in which case it is not a question of any kind of killing (the ghost having left, the machine may be turned off). The pro-life side in general hesitated between (a) taking the feeding-tube withdrawal as a case of Type 1a above (murder) or (b) admitting it to be a case of Type 3 killing (euthanasia), but (i) denying the overall moral permissibility of this type of killing or (ii) denying that Terri would have wished to be killed in this way (the position of Terri's parents).

There were thus three separate conflicts going on in this case. One is between those on both sides who admit that it was a Type 3 killing, but differ on whether Type 3 is permissible. A different conflict was the one about the definition of death, whether higher-brain death may be equated with death simpliciter. The key conflict legally, was the third, what Terri herself would have wished. As I understand it, the legal battle revolved only around the evidence in the third conflict, and was resolved in favor of Michael Schiavo.

(I should insert here that an excellent discussion on the question of higher-brain death has been carried on between the blogs Siris and Mixing Memory. Start here or here and trace the links back; it's worth the trouble. Rarely has the blogosphere reached such a high level.)

Since Terri Schiavo's death is now a fait accompli on any definition, I fortunately am free from the pressing obligation to come to any conclusion about that particular case. I am inclined to agree with those who find all Type 3 killings problematic; and I am inclined to agree with those who deny that higher-brain death should be equated with death simpliciter.

Nevertheless, my principal reaction to the Schiavo case was not intellectual, but emotional. Terri Schiavo literally gave me nightmares. I found her condition disturbing, not necessarily for her sake (although her fate was a grim one), but for the sake of those around her. I did find myself thinking about an advance directive, one that would fulfill every fondest wish of the pro-euthanasia lobby, but — not for my own sake. Should I ever have the misfortune to fall into a persistent vegetative state, I would wish to spare my loved ones years of pain, expense, false hopes, and the daily horror of seeing my empty, grinning face where once they saw a husband, a father, or a brother. I would hope that decisive action would put a quick end, not to my suffering, but theirs. I am sure that many other people must have had this reaction.

Now here is my question: What is the moral standing of such an advance directive? It does not fall easily under Type 3, because it is not for B's sake that A (the family by means of the doctor) kills B (allows B to die), but because B wishes to die for A's sake. This also disqualifies it from being Type 4. It seems to me to be closest to Type 5 (self-sacrifice). And of the five types I outlined above, Type 5, I believe, is never immoral, just as Type 1a is always immoral.

That's my thought as of right now; but I'm far from certain. I'd be interested in hearing what others think. Is self-sacrifical euthanasia (SSE) morally permissible? Or is it just another attempt to play God? Have I let my emotions run away with me?


Anonymous said...

It is really hard to ascertain what the facts are in this case. But it does give us much on which to chew. I appreciate your deliberation.

Evan said...

Is type-3 killing the extent euthanasia? I think euthanasia is, as Paul described it, "A kills B for the sake of B as perceived by A," or "A kills B for the sake of society," which is the ugly doomsday scenario of euthanasia. Assisted suicide is one component of euthanasia, but perhaps another type is needed to fully categorize it.

Thanks for the thoughtful post.