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Killing someone who has not consented to being killed can
properly be regarded as euthanasia only when the motive for
killing is the desire to prevent unbearable suffering on the part
of the person killed. It is, of course, odd that anyone acting from
this motive should disregard the wishes of the person for whose
sake the action is done. Genuine cases of involuntary euthanasia
appear to be very rare.
Non-voluntary Euthanasia
These two definitions leave room for a third kind of euthanasia.
If a human being is not capable of understanding the choice
between life and death, euthanasia would be neither voluntary
nor involuntary, but non-voluntary. Those unable to give consent
would include incurably ill or severely disabled infants, and
people who through accident, illness, or old age have permanently
lost the capacity to understand the issue involved, without
having previously requested or rejected euthanasia in these
circumstances.
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Practical Ethics
Several cases of non-voluntary euthanasia have reached the
courts and the popular press. Here is one example. Louis Repouille
had a son who was described as 'incurably imbecile',
had been bed-ridden since infancy and blind for five years.
According to Repouille: 'He was just like dead all the time .... He
couldn't walk, he couldn't talk, he couldn't do anything: In
the end Repouille killed his son with chloroform.
In 1988 a case arose that well illustrates the way in which
modem medical technology forces us to make life and death
decisions. Samuel Linares, an infant, swallowed a small object
that stuck in his windpipe, causing a loss of oxygen to the brain.
He was admitted to a Chicago hospital in a coma and placed
on a respirator. Eight months later he was still comatose, still
on the respirator, and the hospital was planning to move Samuel
to a long-term care unit. Shortly before the move, Samuel's
parents visited him in the hospital. His mother left the room,
while his father produced a pistol and told the nurse to keep
away. He then disconnected Samuel from the respirator, and
cradled the baby in his arms until he died. When he was sure
Samuel was dead, he gave up his pistol and surrendered to
police. He was charged with murder, but the grand jury refused
to issue a homicide indictment, and he subsequently received
a suspended sentence on a minor charge arising from the use
of the pistol.
Obviously, such cases raise different issues from those raised
by voluntary euthanasia. There is no desire to die on the part
of the infant. It may also be questioned whether, in such cases,
the death is carried out for the sake of the infant, or for the sake
of the family as a whole. If Louis Repouille's son was 'just like
dead all the time', then he may have been so profoundly braindamaged
that he was not capable of suffering at all. That is also
likely to have been true of the comatose Samuel Linares. In that
case, while caring for him would have been a great and no
doubt futile burden for the family, and in the Linares case, a
drain on the state's limited medical resources as well, the infants
180
Taking Life: Humans
were not suffering, and death could not be said to be in, or
contrary to, their interests. It is therefore not euthanasia, strictly
speaking, as I have defined the term. It might nevertheless be
a justifiable ending of a human life.
Since cases of infanticide and non-voluntary euthanasia are
the kind of case most nearly akin to our previous discussions
of the status of animals and the human fetus, We shall consider
them first.
JUSTIFYING INFANTICIDE AND
NON-VOLUNTARY EUTHANASIA
I As we have seen, euthanasia is non-voluntary when the subject
has never had the capacity to choose to live or die. This is
the situation of the severely disabled infant or the older human
being who has been profoundly intellectually disabled
since birth. Euthanasia or other forms of killing are also nonvoluntary
when the subject is not now but once was capable
of making the crucial choice, and did not then express any
preference relevant to her present condition.
The case of someone who has never been capable of choosing
to live or die is a little more straightforward than that of a person
who had, but has now lost, the capacity to make such a decision.
We shall, once again, separate the two cases and take the more
straightforward one first. For simplicity, I shall concentrate on
infants, although everything I say about them would apply to
older children or adults whose mental age is and has always
been that of an infant.
Life and Death Decisions for Disabled Infants
If we were to approach the issue of life or death for a seriously
disabled human infant without any prior discussion of the ethics
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Practical Ethics
of killing in generaL we might be unable to resolve the conflict
between the widely accepted obligation to protect the sanctity
of human life, and the goal of reducing suffering. Some say that
such decisions are 'subjective', or that life and death questions
must be left to God and Nature. Our previous discussions have,
however, prepared the ground, and the principles established
and applied in the preceding three chapters make the issue much
less baffling than most take it to be.
In Chapter 4 we saw that the fact that a being is a human
being, in the sense of a member of the species Homo sapiens,
is not relevant to the wrongness of killing it; it is, rather, characteristics
like rationality, autonomy, and self-consciousness
that make a difference. Infants lack these characteristics. Killing