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All these remarks have been concerned with the wrongness
of ending the life of the infant, considered in itself rather than
for its effects on others. When we take effects on others into
account, the picture may alter. Obviously, to go through the
whole of pregnancy and labour, only to give birth to a child
who one decides should not live, would be a difficult, perhaps
heartbreaking, experience. For this reason many women would
prefer prenatal diagnosis and abortion rather than live birth with
the possibility of infanticide; but ifthe latter is not morally worse
than the former, this would seem to be a choice that the woman
herself should be allowed to make.
Another factor to take into account is the possibility of adoption.
When there are more couples wishing to adopt than normal
children available for adoption, a childless couple may be
prepared to adopt a haemophiliac. This would relieve the
mother of the burden of bringing up a haemophiliac child, and
enable her to have another child, if she wished. Then the replaceability
argument could not justify infanticide, for bringing
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Taking Life: Humans
the other child into existence would not be dependent on the
death ofthe haemophiliac. The death ofthe haemophiliac would
then be a straightforward loss of a life of positive quality, not
outweighed by the creation of another being with a better life.
So the issue of ending life for disabled newborn infants is not
without complications, which we do not have the space to
discuss adequately. Nevertheless the main point is clear: killing
a disabled infant is not morally equivalent to killing a person.
Very often it is not wrong at all.
Other Non-voluntary Life and Death Decisions
In the preceding section we discussed justifiable killing for
beings who have never been capable of choosing to live or die.
Ending a life without consent may also be considered in the
case of those who were once persons capable of choosing to
live or die, but now, through accident or old age, have permanently
lost this capacity, and did not, prior to losing it, express
any views about whether they wished to go on living in such
circumstances. These cases are not rare. Many hospitals care for
motor accident victims whose brains have been damaged beyond
all possible recovery. They may survive, in a coma, or
perhaps barely conscious, for several years. In 1991, the Lancet
reported that Rita Greene, a nurse, had been a patient at D.C.
General Hospital in Washington for thirty-nine years without
knowing it. Now aged sixty-three, she had been in a vegetative
state since undergoing open heart surgery in 1952. The report
stated that at any given time, between 5,000 and 10,000 Americans
are surviving in a vegetative state. In other developed
countries, where life-prolonging technology is not used so aggressively,
there are far fewer long-term patients in this
condition.
In most respects, these human beings do not differ importantly
from disabled infants. They are not self-conscious, rational,
or autonomous, and so considerations of a right to life
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Practical Ethics
or of respecting autonomy do not apply. If they have no experiences
at all, and can never have any again, their lives have
no intrinsic value. Their life's journey has come to an end. They
are biologically alive, but not biographically. (If this verdict
seems harsh, ask yourself whether there is anything to choose
between the following options: (a) instant death or (b) instant
coma, followed by death, without recovery, in ten years' time.
I can see no advantage in survival in a comatose state, if death
without recovery is certain.) The lives of those who are not in
a coma and are conscious but not self-conscious have value if
such beings experience more pleasure than pain, or have preferences
that can be satisfied; but it is difficult to see the point
of keeping such human beings alive if their life is, on the whole,
miserable.
There is one important respect in which these cases differ
from disabled infants. In discussing infanticide in the final section
of Chapter 6, I cited Bentham's comment that infanticide
need not 'give the slightest inquietude to the most timid imagination'.
This is because those old enough to be aware of the
killing of disabled infants are necessarily outside the scope of
the policy. This cannot be said of euthanasia applied to those
who once were rational and self-conscious. So a possible objection
to this form of euthanasia would be that it will lead to
insecurity and fear among those who are not now, but might
come to be, within its scope. For instance, elderly people, knowing
that non-voluntary euthanasia is sometimes applied to senile
elderly patients, bedridden, suffering, and lacking the capacity
to accept or reject death, might fear that every injection or tablet
will be lethal. This fear might be quite irrational, but it would
be difficult to convince people of this, particularly if old age
really had affected their memory or powers of reasoning.
This objection might be met by a procedure allowing those
who do not wish to be subjected to non-voluntary euthanasia
under any circumstances to register their refusal. Perhaps this
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Taking Life: Humans
would suffice; but perhaps it would not provide enough reassurance.
If not, non-voluntary euthanasia would be justifiable
only for those never capable of choosing to live or die.
JUSTIFYING VOLUNTARY EUTHANASIA
Under existing laws in most countries, people suffering uruelievable
pain or distress from an incurable illness who beg their
doctors to end their lives are asking their doctors to risk a murder
charge. Although juries are extremely reluctant to convict in
cases of this kind the law is clear that neither the request, nor