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
Review/Preview
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Course specifics:
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Website and notes: www.chass.utoronto.ca/~kirstin
Lecture format:
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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
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Lecture 1 Outline:
1.
Suicide – definition
2.
Kant’s arguments against suicide
3.
Brandt’s pilot case
4.
Brandt’s rebuttal of common arguments against suicide
5.
Brandt’s 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 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?
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Kant/Brandt
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Deontological position (Kant): “suicide is in no
circumstances permissible” (388)
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Utilitarian/Consequentialist position (Brandt):
“suicide is sometimes morally acceptable” (391)
Kant
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Recall: an ethics of respect for persons
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“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)
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“To use life for its own destruction, to use life for
producing lifelessness is self-contradictory” (388)
Kant
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Irrationality Argument (Self-contradiction)
1.
2.
3.
4.
5.
6.
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]
Kant
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Focus: The Irrationality Premise
Example: slavery and freedom (J.S.Mill On Liberty)
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Counter-examples:
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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
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1.
2.
3.
4.
5.
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]
Kant
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Focus: The Stewardship Premise
Reasons for accepting this premise?
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Hume’s Objection:
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“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’]
Hume’s Objection
In logical form:
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1.
2.
3.
4.
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
Kant’s Reply
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“We must draw a distinction between a suicide
and a victim of fate…[w]hat constitutes suicide
is the intention to destroy oneself ” (389)
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You are a victim of fate if, had you been given
another option, you would have taken it.
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Example: soldier throwing himself on live grenade
Doctrine of Double Effect
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“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
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Foresee / Intend (the consequences of an action)
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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
Kant’s Reply (continued)
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Recall: Suicide is “the intentional termination of one’s
own life”
What constitutes ‘intent’?
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For Kant, intent includes the final objective of the act
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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
Brandt’s Pilot Case
Brandt’s Pilot Case
Brandt
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Option 1: stay in the plane, bring it down where it will
do little damage - at the cost of certain death for
himself
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Option 2: bail out of the plane, let it fall where it will
(very possibly killing a good number of people) - he
survives
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Option 1 looks like it is suicide AND morally permissible
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How would Kant respond?
Intention
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Kant: this is not an act of suicide, but rather of selfsacrifice
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.
Understanding Brandt
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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
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A. St. Augustine, 6th Commandment
Modern Messages – New Orleans
1998
Brandt’s Objections
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God prohibits suicide and we are bound by divine
command
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Objection 1: “arbitrary exegesis” (392)
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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
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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)
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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
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2. Natural Law Argument
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St. Thomas (Aquinas):
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“Wherefore suicide is
contrary to the inclination
of nature…[it] is always a
mortal sin.” (393)
Brandt’s Objections
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Objection 1: Humans are not always morally bound to
do what they have ‘natural inclination’ to do
(Natural/Moral come apart)
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Examples: Chastity
Violence/Aggression?
Adultery?
Addiction?
Brandt’s Objections
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Objection 2: Some people do have a strong
‘natural inclination’ to die
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“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
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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…
Brandt’s Objection
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(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)
Brandt’s Conclusions
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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
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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
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Rational weighing of future life-courses (judgment) may
be insidiously influenced by depression
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Also ‘goal-gradient’ phenomenon (difficulty with time
indifference)
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Brandt is concerned about these influences
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Considers the role of other persons in dealing with
these problems
Brandt and the Role of Other
Persons
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“What is the moral obligation of other persons toward
those who are contemplating suicide?” (397)
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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)
Moral Obligations to Others – The
Pond Case
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Thought experiment to
motivate the principle –
child in the ornamental
pond
Obligations to Others
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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)
Implications for Brandt
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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
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There are also broad social implications of this
moral principle
Broad Implications
Implications - Poverty
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Relative poverty – when people are poor relative to the wealth of others
Absolute poverty – poverty by any standard
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“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
Rich/Poor Gap and Moral
Obligations to Others
Wealthiest 1/5th of the
population controls 85% of
the global income
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Poorest 1/5th of the
population controls 1.4%
of the global income
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Britain’s richest 10 people have as much wealth as 23 countries
with over 174 million people
Broad Implications of the Obligation
to Assist
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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.
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Discussion
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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 one’s own life”
1.
2.
3.
4.
5.
6.
7.
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
Next Class
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Morality of suicide as it arises in the medical
context. Special case:
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Euthanasia
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And next Monday: Physician-Assisted Suicide
Contact
Prof. Kirstin Borgerson
Room 359S Munk Centre for International Studies
Office Hours: Tuesday 3-5pm
Course Website: www.chass.utoronto.ca/~kirstin