Required Readings to Accompany these Lecture Notes:
The Elements of Moral Philosophy: Chapter 7, "The Utilitarian Approach"
James Rachels, "The Morality of Euthanasia" (in CourseDen)
We have already studied a few different theories of morality:
· Moral Skepticism … one form of which is Cultural Relativism.
· Moral Realism … one form of which is Divine Command Theory.
Now we will consider two other theories… or rather, two families of theories: Consequentialism and Deontology.
Consequentialism (df.): whether or not an action is moral depends only its consequences (in other words, only on its effects); if it has good consequences, then it is moral, and if it has bad consequences, then it is immoral. Nothing else is relevant to whether the action is moral.
There are two types of Consequentialist theory (which is why it’s really a family of theories rather than a single theory): Utilitarianism and Ethical Egoism.
Utilitarianism (df.): the morally right thing to do is to create overall good consequences—including happiness and well-being—for everyone who could be affected by your actions, including but not limited to yourself and your loved ones. [This is the theory that you read about in EMP ch.7.]
· Utilitarianism implies that a morally right action can have bad effects for some so long as they are outweighed by good effects for others; for example, an action can decrease some people’s happiness so long as it causes the overall amount of happiness in the world to go up.
· One of the founders of Utilitarianism, Jeremy Bentham (1748–1832) summarized the idea as the Principle of Utility, which “requires us, in all circumstances, to produce the most happiness and the least unhappiness that we can” (EMP p.101).
· The name of the theory comes from the word utility (df.): usefulness.
Ethical Egoism (df.): the morally right thing to do is to create good consequences for yourself; the effects of your actions on other people are morally irrelevant so long as they are not bad for you.
· Recall Rachels' Minimum Conception of Morality: "Morality is, at the very least, the effort to guide one's conduct by reason—that is, to do what there are the best reasons for doing—while giving equal weight to the interests of each individual affected by one's decision" (EMP p.13). Ethical Egoism says that the interests of other people are morally irrelevant. So if you accept Rachels' Minimum Conception, you should say: Ethical Egoism isn't even a theory of morality at all!
· We will not be focusing on Ethical Egoism in this introductory class. From this point forward, the only sort of consequentialism we will be talking about is Utilitarianism, which is by far the more popular form of Consequentialism. For more on Ethical Egoism, see EMP ch.5, which is not among your assigned readings.
The other family of moral theories we will be consider in the coming weeks is Deontology:
Deontology (df.): the morality of an action does not depend on its consequences; sometimes you should perform an action even if it would have bad overall effects, and sometimes should not perform an action even if it would have good overall effects.
· For example, a Deontologist could say (but doesn’t necessarily have to say) that it is always wrong to kill an innocent person, no matter what the specific circumstances, and no matter what good consequences might result from doing so. And a Deontologist could say (but doesn’t necessarily have to say) that it is always wrong to steal, no matter what the situation is.
· The name “Deontology” comes from the Greek word "deon", meaning duty or obligation.
· We will discuss deontology at length when we study the ethical theory of Immanuel Kant, beginning in module 10.
An illustration of the different answers that Utilitarianism, Ethical Egoism and Deontology might give to the same moral question is found in the story of Jim the Explorer:
Jim finds himself in the central square of a small South American town. Tied up against the wall are a row of twenty Indians, most terrified, a few defiant, in front of them several armed men in uniform. A heavy man in a sweat-stained khaki shirt turns out to be the captain in charge and, after a good deal of questioning of Jim which establishes that he got there by accident while on a botanical expedition, explains that the Indians are a random group of the inhabitants who, after recent acts of protest against the government, are just about to be killed to remind other possible protestors of the advantages of not protesting. However, since Jim is an honored visitor from another land, the captain is happy to offer him a guest’s privilege of killing one of the Indians himself. If Jim accepts, then as a special mark of the occasion, the other Indians will be let off. Of course, if Jim refuses, then there is no special occasion, and Pedro here will do what he was about to do when Jim arrived, and kill them all. Jim, with some desperate recollection of schoolboy fiction, wonders whether if he got hold of a gun, he could hold the captain, Pedro and the rest of the soldiers to threat, but it is quite clear from the set-up that nothing of the sort is going to work: any attempt at that sort of thing will mean that all the Indians will be killed, and himself. The men against the wall, and the other villagers understand the situation, and are obviously begging him to accept. What should he do?[1]
Utilitarianism will say: Jim should do whatever will have the best results for the most people. So if Jim is a Utilitarian, he will take the gun and shoot one Indian to save the rest. This will be bad for the one protestor who dies, as well as for his friends and family who will grieve his death. But it will be good for the 19 people whose lives are saved, as well as for their friends and families. He will be killing one person in order to save 19, and that's the option with the best overall consequences.
Ethical Egoism will say: Jim should do whatever will have the best results for himself. If Jim is an Ethical Egoist, he will ask himself which course of action will help him the most, regardless of how it does or doesn’t affect the protestors and their families. For example, he might think that if he gets kills one of the protestors, he might have nightmares later, or he might develop PTSD. In that case, he would decide against killing the protestor and doing what’s best for himself going forward, even if it means that all 20 protestors die.
Deontology can* say: killing an innocent person is always wrong, even if doing so will have good effects (like saving the lives of 19 other people). You should never kill an innocent person, even if doing so will have really good consequences. So if Jim is a Deontologist, he can refuse to take the gun and kill one protestor. He can allow the soldiers to kill all 20 Indians. Even though more people will die, Jim will have avoided performing an immoral act: killing an innocent person himself.
*A Deontologist doesn’t necessarily have to say this. This is an option for a Deontologist but not for a Utilitarian or an Ethical Egoist.
OPTIONAL VIDEO: "Utilitarianism Pt.1" (Wi-Phi, 4:31)
Note: this video explains Utilitarianism as seeking to increase the overall amount of happiness. As we will see in a later module, some Utilitarians seek to increase, not just overall happiness, but overall well-being.
In the remainder of this module and in the next two modules, we will examine how Utilitarianism can be applied to three practical moral issues:
· euthanasia
· the SARS-CoV-2 pandemic
· world poverty
The term "euthanasia" comes from the Greek "eu" (meaning "good") and "thanos" (meaning "death"). It refers to the practice of allowing someone to die, or helping to bring about that person's death, in order to end their suffering or to respect their wishes.
The word "euthanasia" is used in different ways, especially in the news media. It can mean any of the following: passive euthanasia, active euthanasia, or physician assisted suicide.
passive euthanasia (df.) the form of euthanasia in which a patient is allowed to die "naturally" by the removal of life-support, such as the removal of a respirator or a feeding-tube, or by omitting life-saving actions, such as a surgery that's needed to keep them alive. [In general, the word "passive" is "used to describe someone who allows things to happen or who accepts what other people do or decide without trying to change anything" (Merriam-Webster).]
· A very famous case of passive euthanasia is that of Terri Schiavo. She lived in a persistent vegetative state for many years until her feeding tube was removed, leading to her eventual death.
active euthanasia (df.): the form of euthanasia in which someone, like a doctor or other medical professional, actively intervenes in order to cause the death of the patient, such as when a patient is injected with drugs that bring about their death.
· Currently, it is legal in only a few countries:
· the Netherlands
· Luxembourg
· Belgium[2]
· Colombia
· Canada
· Western Australia[3]
· Spain[4]
· New Zealand (starting in late 2021)[5]
· It is not legal anywhere in the United States.
· As described in your reading for this module, this is how Sigmund Freud died, with the assistance of Max Schur (EMP p.100-101).
· This is also the practice for which Michigan physician Dr. Jack Kevorkian (1928–2011) was found guilty of second-degree murder and served several years in prison.[6]
physician-assisted suicide (df.): the form of euthanasia that occurs when a patient has been diagnosed with a fatal disease and brings about their own death by taking a lethal dose of drugs received via a doctor's prescription. The doctor's "assistance" comes in the form of writing a prescription for the lethal dose of drugs—the physician does not directly kill the patient, as in active euthanasia.
OPTIONAL VIDEO: Jack Kevorkian and the Right to Die (Retro Report | New York Times, 14:39). This video features both Dr. Kevorkian, who went to prison in Michigan for practicing active euthanasia, and Brittany Maynard, who moved to Oregon in order to take advantage of legalized physician-assisted suicide. [Note that some of the information in the video is outdated: it says that assisted suicide is legal in only five states, which was true in 2015 when the video was produced. It is now legal in more states—see below.]
In the United States, physician-assisted suicide is legal only in:
· Oregon
· Washington
· Montana
· Vermont
· California
· Colorado
· Washington, D.C.
· Hawaii
· New Jersey[8]
· Maine[9]
Oregon was the first state to legalize the practice.
Oregon's "Death With Dignity Act"
· The law requires that two physicians diagnose a patient as terminally ill (meaning that they have only six months or less to live) and judge that the patient is of sound mind (they are not mentally ill).
· The patient must ask his or her doctor to write a prescription for a lethal dose of drugs, but then wait 15 days and request the prescription again before receiving it.
· The patient must then go to a pharmacy that will fill the prescription.
· The patient must administer the drugs himself or herself. No one else can administer the drugs to the patient—that would be active euthanasia and would be illegal.
· The drugs most frequently prescribed by physicians are the barbiturates Secobarbital and Pentobarbital.
· Most people who request the drugs have terminal cancer.
· Since 1998 (the year that the Act went into effect) and 2019, a total of 2,518 people in Oregon have received prescriptions, and 1,657 people of them have used the prescribed drugs to commit suicide. That total includes 170 people who killed themselves in 2019.[10]
Next we will examine James Rachels' defense of active euthanasia, in his article “The Morality of Euthanasia.”
Rachels says that the strongest argument in support of euthanasia is the Argument from Mercy.
He considers two versions of this argument:
1. the Utilitarian Version (p.2)
2. the Utility & Rights Version (p.3)
He identifies some serious problems with the first (Utilitarian version) and changes it to the second (Utility & Rights) version in order to avoid those problems.
Here is the first version of the Argument from Mercy… Rachels believes that there is a big problem with this argument:
The Argument from Mercy (Utilitarian Version)
1. Any action or social policy is morally right if it serves to increase the amount of happiness in the world or to decrease the amount of misery. Conversely, an action or social policy is morally wrong if it serves to decrease happiness or to increase misery. [This is a statement of utilitarianism.]
2. The policy of killing, at their own request, hopelessly ill patients who are suffering pain [i.e., active euthanasia] would decrease the amount of misery in the world [such as in Rachels' story about Jack, the cancer patient].
3. Therefore, such a policy would be morally right. (p.2)
As Rachels points out, many contemporary philosophers think that there is a problem with premise 1: it implies that happiness and the avoidance of misery are the only, or at least the most important, moral values. But there are other things that are also morally important:
· freedom;
· justice; and
· respect for individual rights.
To illustrate this point, Rachels focuses on freedom of religion:
… people might be happier if there were no freedom of religion, for if everyone adhered to the same religious belief, there would be greater harmony among people. There would be no unhappiness caused within families by Jewish girls marrying Catholic boys, and so forth. Moreover, if people were brainwashed well enough, no one would mind not having freedom of choice. Thus happiness would be increased. But, the argument continues, even if happiness could be increased this way, it would not be right to deny people freedom of religion, because people have a right to make their own choices. Therefore, the first premise of the utilitarian argument is unacceptable. (p.3)
He then considers an even more extreme example, one that is more relevant to euthanasia: the right to life:
Suppose a person is leading a miserable life—full of more unhappiness than happiness—but does not want to die. This person thinks that a miserable life is better than none at all. Now I assume that we would all agree that the person should not be killed; that would be plain, unjustifiable murder. Yet it would decrease the amount of misery in the world if we killed this person—it would lead to an increase in the balance of happiness over unhappiness—and so it is hard to see how, on strictly utilitarian grounds, it could be wrong. (p.3)
There are things beside happiness that are morally valuable, including personal freedom and autonomy:
autonomy (df.): a person's capacity to make decisions for himself or herself; the ability to guide one's own life. [from the Greek words auto, self, and nomos, law]
So happiness, it seems, cannot be the only standard of morality.
[7.4.2.] The Argument from Mercy: Utility & Rights Version.
But obviously, happiness is morally important. We don't have to abandon utilitarianism entirely. As Rachels says, "when an action or a social policy would decrease misery, that is a very strong reason in its favor." (p.3)
With this in mind, Rachels proposes a second, improved version of the Argument from Mercy.
The Argument from Mercy (Utility & Rights Version)
1. If an action promotes the best interests of everyone concerned and violates no one's rights, then that action is morally acceptable.
2. In at least some cases, active euthanasia promotes the best interests of everyone concerned and violates no one's rights.
3. Therefore, in at least some cases, active euthanasia is morally acceptable. (p.3)
This version differs from the first version by incorporating a concern for individual rights.
This is a valid argument. If the premises were both true, then that would guarantee that the conclusion is true. (Remember, an argument does not have to have true premises in order to be valid. Validity has to do with the logical connection between premises and conclusion, not with the actual truth or falsity of the premises.)
But is it sound? That is, given that the argument is valid, is it also the case that its premises are true? [I am leaving this an open question… you should form your own opinion about this.]
[7.4.3.] Active and Passive: Morally Equivalent?
James Rachels' defense of active euthanasia does not end with the Argument from Mercy.
In another article (not in your textbook), Rachels argued that active euthanasia is morally equivalent to passive euthanasia. In other words, if active euthanasia is immoral, then so is passive euthanasia; and if passive euthanasia is morally permissible, then so is active euthanasia.
Since most people believe that passive euthanasia is sometimes moral, this is supposed to convince them that active euthanasia is, too.
On Rachels' view, there is no moral difference between killing someone and letting him die when you could easily save him.
For example, there is no moral difference between deliberately causing someone to drown (by holding his head under the water) and neglecting to save someone from drowning when you could easily save his life.
Rachels tells the story of Smith and Jones in order to illustrate this point:
… Smith stands to gain a large inheritance if anything should happen to his six-year-old cousin. One evening while the child is taking his bath, Smith sneaks into the bathroom and drowns the child, and then arranges things so that it will look like an accident.
… Jones also stands to gain if anything should happen to his six-year-old cousin. Like Smith, Jones sneaks in planning to drown the child in his bath. However, just as he enters the bathroom, Jones sees the child slip and hit his head, and fall face down in the water. Jones is delighted; he stands by, ready to push the child's head back under if it is necessary, but it is not necessary. With only a little thrashing about, the child drowns all by himself, "accidentally," as Jones watches and does nothing.[11]
In the Smith and Jones thought experiment, the two men's motives are the same (they both want the boy to die so that they will inherit a lot of money), and the consequences are the same (the boy dies in each case). This explains why Smith and Jones are both equally bad, even though only one of them (Smith) actively brings about the death of his cousin.
Rachels applies the same reasoning to the case of euthanasia: If the motives are the same (what is desired is that the patient's suffering end), and the consequences are the same (the patient dies), then there is no moral difference between active and passive. The fact that in active euthanasia, someone actively intervenes so as to bring about the death of the patient, makes no moral difference. It is morally the same as passive euthanasia.
In effect, Rachels is rejecting…
the Doctrine of Doing and Allowing (df.): "It is always morally worse to do harm than to allow that same harm to occur."[12]
By denying this doctrine, Rachels is taking the view that it is not always worse to actively cause harm than it is to passively allow that harm to happen.
On his view, causing a harm and allowing it to happen are sometimes morally the same.
Information contained in these footnotes is provided in case you are interested in further reading. You will not be quizzed on the information given in these footnotes or on the websites to which they link. However, you should feel free to refer to this material in your discussion board posts.
[1] Bernard Williams' "Utilitarianism and Integrity," in Rachels, The Right Thing to Do, p.41.
[2] Belgium has recently begun permitting active euthanasia for children as young as nine years old. See Charles Lane, “Children are Being Euthanized in Belgium,” Washington Post, August 6, 2018.
[3] “Voluntary Assisted Dying,” Government of Western Australia Department of Health.
[4] “Spain will become the sixth country worldwide to allow euthanasia and assisted suicide,” BMJ, January 15, 2021.
[5] “New Zealand Euthanasia: Assisted dying to be legal for terminally ill people,” BBC News, October 30, 2020.
[6] Kevorkian died in June 2011. For more information about him, see this online biography.
[7] Daniel E. Slotnik, "Brittany Maynard, 'Death With Dignity' Ally, Dies at 29", New York Times, Nov. 3, 2014.
[8] “New Jersey will now allow terminally ill patients to end their lives,” CNN, April15, 2019.
[9] Kristin Lam, “Maine Legalizes Medically Assisted Suicide, Joining Seven Other States and District of Columbia,” USA Today, June 12, 2019.
[10] “Annual Report” on Oregon’s Death with Dignity Act, State of Oregon Department of Human Services.
[11] James Rachels, "Active and Passive Euthanasia," New England Journal of Medicine 292, no.2 (1975), pp.78-80.
[12] Russ Shafer-Landau, The Fundamentals of Ethics, Oxford University Press, 2010, p.215. For more information on this doctrine, see Howard-Snyder, Frances, "Doing vs. Allowing Harm", The Stanford Encyclopedia of Philosophy (Winter 2011 Edition), Edward N. Zalta (ed.), retrieved June 2, 2016.