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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 |
190 |
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 |
191 |
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 |
192 |
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 |
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