The End of Life
Euthanasia and Morality


James Rachels

(Oxford University Press, 1986)
published in English, Italian, Japanese, Dutch, and Serbo-Croatian


Download the book: Front Matter  (.pdf file)  Chapter 1  (.pdf file)  Chapter 2  (.pdf file)  Chapter 3  (.pdf file)  Chapter 4  (.pdf file)  Chapter 5  (.pdf file)  Chapter 6  (.pdf file)  Chapter 7  (.pdf file)  Chapter 8  (.pdf file)  Chapter 9  (.pdf file)  Chapter 10  (.pdf file)  Back Matter  (.pdf file) 

The rest of this page contains the book's table of contents and introduction.


Contents

Introduction 1

1. The Western tradition

The origins of the tradition 7
The doctrine of innocence 11
The importance of being human 13
Intentional killing 15
Other views about euthanasia 17

2. The sanctity of life

The Eastern tradition 20
Preliminary objections to the traditional views 23
A new understanding of the sanctity of life 24
The moral rule against killing 27
Some practical implications 28
Morality and religion 36

3. Death and evil

Death and suffering 39
Hedonism 45
The concept of a life 49

4. 'Innocent humans'

The case of Baby Jane Doe 60
The fundamental issue 62
Subnormal lives 64
'An innocent human' 67

5. Suicide and euthanasia

Barney Clark's key 78
What the key signified 79
Suicide 80
The link to euthanasia 85

6. Debunking irrelevant distinctions

Distinctions made in traditional medical ethics 88
Intentional and non-intentional termination of life 92
Ordinary and extraordinary means of treatment 96
The effect of debunking irrelevant distinctions 100

7. Active and passive euthanasia

Killing and letting die 106
Practical consequences of the traditional view 108
The Bare Difference Argument 111
Counter-arguments 114
The physician's commitments 118
Thomson's objection 121
The Compromise View 123

8. Further reflections on killing and letting die

The status of intuitions 129
The Jack Palance Argument 134
The No Relevant Difference Argument 139
The radical nature of the Equivalence Thesis 143
A final word about intuitions 148

9. The morality of euthanasia

An absolute rule? 151
The argument from mercy 152
The argument from the Golden Rule 158
Religious arguments 160
The possibility of unexpected cures 165

10. Legalizing euthanasia

Morality and law 168
How mercy-killers are treated in court 168
The slippery-slope argument 170
The argument from liberty 180
How to legalize euthanasia 182

Notes on sources 188
Index 197


Introduction

David Hume, the great Scottish philosopher of the eighteenth century, remarked that the aim of philosophy should be to replace 'superstition and false religion' with reason and understanding. Hume realized that our thinking about even the most commonplace matters may be corrupted by false assumptions--and we may take these assumptions so much for granted that we never even think of questioning them. Our moral thinking is especially vulnerable to this sort of corruption. We absorb the prejudices of our culture and the mistakes of our parents, mix in the pronouncements of our religion, add the influence of our selfishness, and then regard the resulting belief as the merest common sense. We end up, like the Greeks and Callatians in Herodotus' story, with strong convictions but with little to support them:

Darius, after he had got the kingdom, called into his presence certain Greeks who were at hand, and asked--'What he should pay them to eat the bodies of their fathers when they died?' To which they answered, that there was no sum that would tempt them to do such a thing. He then sent for certain Indians, of the race called Callatians, men who eat their fathers, and asked them, while the Greeks stood by, and knew by the help of an interpreter all that was said--'What he should give them to burn the bodies of their fathers at their decease?' The Indians exclaimed aloud, and bade him forbear such language. Such is men's wont herein; and Pindar was right, in my judgement, when he said, 'Custom is the king o'er all.'

Herodotus concluded from this that morality is nothing more than customs and feelings--and indeed, it is easy for morality to degenerate into that, if we are content with 'superstition and false religion'. But morality should be a matter of reason as well as feeling. Following Hume's admonition, we should ask why we accept the rules we do, what interests (if any) they serve, and what values (if any) they protect.

In this essay I shall examine the ideas and assumptions that lie behind one of the most important moral rules, the rule against killing. Killing people is, in general, wrong. But why is it wrong, and when may exceptions be made?

In considering these questions, I will assume that moral philosophy may be revisionary, and not merely descriptive. It is not our business simply to expound what we already happen to believe. What we believe may be naive or mistaken. I shall assume that we may reject received opinion if it goes against reason. Where killing is concerned, I believe that the dominant moral tradition of our culture is, in fact, contrary to reason. The material presented in this essay adds up to a systematic argument against the traditional view and a defence of an alternative account.

The traditional view

Consider the recent case of Hans Florian and his wife. They had been married for thirty-three years when he shot her dead. She was a victim of Alzheimer's disease, which attacks the brain, and for which there is no known cause or cure. The effects of the disease are devastating. The deterioration of the brain can be traced through several stages, as the victim loses all semblance of human personality.

Soon after the onset of the disease, Mrs Florian began to lose the ability to do simple chores and, at the same time, began to develop abnormal fears. She could not drive or write, and would panic when her husband would leave the room. As the disease progressed, he would have to feed her by forcing her mouth open, and he would bathe her and change her clothes several times each day as she soiled them. Then her vocabulary shrank to two words: 'fire' and 'pain', screamed in her native German. Finally, she had to be placed in a nursing home for her own safety. Although her condition was irreversible, it was not 'terminal'--she could have lived on, in this deranged state, indefinitely.

Was it wrong for Hans Florian to have killed his wife? He explained that he killed her because, being seventeen years older, he did not want to die first and leave her alone. Legally, of course, he had no right to do it. Under American law, he could have been found guilty of murder in the first degree--although no charges were brought, because the Florida grand jury refused to indict him. (As we shall see, juries often react this way in such cases.) But, legal questions aside, was his act immoral?

We may certainly feel sympathy for Hans Florian; he faced a terrible situation, and acted from honourable motives. Nevertheless, according to the dominant moral tradition of our culture, what he did was indefensible. He intentionally killed an innocent human being, and, according to our tradition, that is always wrong. This tradition is largely the product of Christian teaching. Christianity says, of course, that every human being is made in the image of God, so all human life is sacred. Killing a person, even one so pitiable as Mrs Florian, is therefore an offence against the Creator.

Most people in the Western world accept some such perspective as this. Even those who imagine themselves to have rejected this doctrine continue, more often than not, to be influenced by it--it is not easy to shrug off the values of the culture in which one has been raised and educated. Thus, even those who reject the old theological ideas may continue to accept their secular equivalents--if one no longer believes that human life is 'sacred', then one can at least believe that human life is 'intrinsically valuable' or that 'every human life has a special dignity and worth'. And, on the strength of this, one may continue to doubt whether Mr Florian acted correctly.

The traditional view is not, however, a simple view. Through the centuries various thinkers have contributed to its development, and a complex account of the morality of killing has resulted. This account appeals to a series of distinctions that, taken together, define a class of actions said to be absolutely forbidden. In deciding whether a particular killing is permissible, the method is to apply the distinction to determine whether the act falls into the forbidden class.

Some of these distinctions have to do with the status of the victim: for example, the distinction between human and non-human is held to be crucial. At the heart of the traditional doctrine is the idea that the protection of human life--all human life--is immensely important. If one is human, and alive, then according to the traditional view one's life is sacred. At the same time, non-human life is given relatively little importance. So, in general, killing people is said to be gravely wrong, while killing other animals requires almost no justification at all.

But this does not mean that killing people can never be justified. Sometimes it is justified, and here it matters a great deal whether the human in question is 'innocent'. Capital punishment and killing in war are traditionally sanctioned, on the grounds that the people who are killed are not innocent. It is the killing of the innocent, such as Mrs Florian, that is prohibited.

Other traditional distinctions focus on other qualities of the act; for example, it matters whether the killing would be intentional. (Like 'innocent', 'intentional' is something of a technical term whose meaning we will have occasion to examine later.) It is the intentional killing of innocent humans that is absolutely forbidden.

But perhaps the most interesting of the traditional distinctions is between killing people and merely letting people die. On the traditional view, even though killing innocent people is forbidden, letting them die is sometimes permitted. This is especially important in considering what may or may not be done in medical treatment. The point is that we are not always required to use every available resource to prolong life, even if it is the life of an innocent human. When extraordinary means are required to keep someone alive, those means may be omitted. (The use of ordinary treatments is morally mandatory, but extraordinary treatments are optional--this is another of the distinctions the traditional view finds so important.)

The traditional theory must be taken seriously; not only has its influence been enormous, but from a philosophical point of view it is the only fully worked-out, systematically elaborated theory of the subject we have. Its development has been one of the great intellectual achievements of Western culture, accomplished by thinkers of great ingenuity and high moral purpose. However, I shall be mainly interested in the question of whether this theory is true--granted that it has history and tradition on its side, still we may ask whether there is good reason for a rational person to accept it.

If the traditional theory is not true, then in our society many decisions concerning life and death are being made on unsound grounds, and the law concerning such matters is badly in need of reform. I believe that the traditional view is mistaken at almost every point. The maze of distinctions on which it is based cannot withstand analysis. Much of this essay is a defence of that judgment.

An alternative view

To replace the traditional view, I offer a different way of looking at such matters. The alternative view begins by pointing out that there is a deep difference between having a life and merely being alive. The point of the moral rule against killing is not to keep 'innocent humans' alive. Being alive, in the biological sense, is relatively unimportant. One's life, by contrast, is immensely important; it is the sum of one's aspirations, decisions, activities, projects, and human relationships. The point of the rule against killing is the protection of lives and the interests that some beings, including ourselves, have in virtue of the fact that we are subjects of lives. Only by paying careful attention to the concept of a life can we understand the value of life and the evil of death.

The details of this account are strikingly different from the traditional approach. The distinction between human and non-human turns out to be less important than has been assumed. From a moral point of view, it is the protection of lives that is important, and so, because most humans have lives, killing them is objectionable. However, some unfortunate humans, such as Mrs Florian, do not have lives, even though they are alive; and so killing them is a morally different matter. Moreover, some non-human animals also have lives, and so consistency requires that they also be protected by the rule against killing.

The other traditional distinctions--between innocence and non-innocence, intentional and non-intentional killing, and ordinary and extraordinary means--also turn out to be not so important. And, I will argue, the distinction between killing and letting die is morally insignificant as well: the fact that one act is an act of killing (for example, 'mercy-killing') while another is an act of 'merely' letting someone die (for example, 'pulling the plug' of a life-sustaining medical device) is not in itself a reason for thinking one act morally better than the other.

The upshot is that this view is much simpler than the traditional view, in that not nearly so many things are considered important. In deciding questions of life and death, the crucial question is: Is a life, in the biographical sense, being destroyed or otherwise adversely affected? If not, the rule against killing offers no objection. The species of the subject of the life, and the means that are used, as well as the intention with which the act is done, are all more or less irrelevant.

As one might suspect, the implication for Mrs Florian is different from the implication of the traditional view. Although this unfortunate woman was still alive, that fact has little significance. The critical fact is that, when her husband shot her, her life was already over. He was not destroying her life; it had already been destroyed by Alzheimer's disease. Thus he was not behaving immorally.

This approach assumes a certain conception of morality. The traditional theory is often presented in theological terms, but its partisans emphasize that the religious trappings are not necessary. It is meant to be a moral view, not a religious dogma, binding on moral agents regardless of their theological convictions or lack of them. My approach is secular in this sense, plus another. It sees being moral, not as a matter of faithfulness to abstract rules or divine laws, but as a matter of doing what is best for those who are affected by our conduct. If we should not kill, it is because in killing we are harming someone. That is the reason killing is wrong. The rule against killing has as its point the protection of the victims.

If this seems a truism, remember Mrs Florian. This conception leads directly to the conclusion that her husband did no wrong. She was not harmed by her husband's killing her--indeed, if anything, it seems more likely that she was helped. But on the traditional view, this has little importance: Mrs Florian was an innocent human, and so she could not intentionally be killed. Against the background of the traditional view, the alternative approach emerges not as a truism but as a radical idea.


--James Rachels

Note: The quotation from Herodotus is from his History, translated by George Rawlinson and excerpted in John Ladd, ed., Ethical Relativism (Belmont, Ca., 1973), p.12.