text stringlengths 0 1.71k |
|---|
If in real life we are unlikely ever to encounter a case of |
justifiable involuntary euthanasia, then it may be best to dismiss |
from our minds the fanciful cases in which one might imagine |
defending it, and treat the rule against involuntary euthanasia |
as, for all practical purposes, absolute. Here Hare's distinction |
between critical and intuitive levels of moral reasoning (see |
Chapter 4), is again relevant. The case described in the preceding |
paragraph is one in which, if we were reasoning at the critical |
level, we might consider involuntary euthanasia justifiable; but |
at the intuitive level, the level of moral reasoning we apply in |
our daily lives, we can simply say that euthanasia is only justifiable |
if those killed either |
lack the ability to consent to death, because they lack the |
capacity to understand the choice between their own continued |
existence or non-existence; or |
2 have the capacity to choose between their own continued life |
or death and to make an informed, voluntary, and settled |
decision to die. |
201 |
Practical Ethics |
ACTIVE AND PASSIVE EUTHANASIA |
The conclusions we have reached in this chapter will shock a |
large number of readers, for they violate one of the most fundamental |
tenets of Western ethics - the wrongness of killing |
innocent human beings. I have already made one attempt to |
show that my conclusions are, at least in the area of disabled |
infants, a less radical departure from existing practice than one |
might suppose. I pointed out that many societies allow a pregnant |
woman to kill a fetus at a late stage of pregnancy if there |
is a significant risk of it being disabled; and since the line between |
a developed fetus and a newborn infant is not a crucial |
moral divide, it is difficult to see why it is worse to kill a newborn |
infant known to be disabled. In this section I shall argue that |
there is another area of accepted medical practice that is not |
intrinsically different from the practices that the arguments of |
this chapter would allow. |
I have already referred to the birth defect known as spina |
bifida, in which the infant is born with an opening in the back, |
exposing the spinal cord. Until 1957, most of these infants died |
young, but in that year doctors began using a new kind of valve, |
to drain off the excess fluid that otherwise accumulates in the |
head with this condition. In some hospitals it then became |
standard practice to make vigorous efforts to save every spina |
bifida infant. The result was that few such infants died - but of |
those who survived, many were severely disabled, with gross |
paralysis, multiple deformities.- of the legs and spine, and no |
control of bowel or bladder. Intellectual disabilities were also |
common. In short, the existence of these children caused great |
difficulty for their families and was often a misery for the children |
themselves. |
After studying the results of this policy of active treatment a |
British doctor, John Lorber, proposed that instead of treating |
all cases of spina bifida, only those who have the defect in a |
mild form should be selected for treatment. (He proposed that |
202 |
, |
I , |
I |
I |
I |
Taking Life: Humans |
the final decision should be up to the parents, but parents nearly |
always accept the recommendations of the doctors.) This principle |
of selective treatment has now been widely accepted in |
many countries and in Britain has been recognised as legitimate |
by the Department of Health and Social Security. The result is |
that fewer spina bifida children survive beyond infancy, but |
those who do survive are, by and large, the ones whose physical |
and mental disabilities are relatively minor. |
The policy of selection, then, appears to be a desirable one: |
but what happens to those disabled infants not selected for |
treatment? Lorber does not disguise the fact that in these cases |
the hope is that the infant will die soon and without suffering. |
It is to achieve this objective that surgical operations and other |
forms of active treatment are not undertaken, although pain |
and discomfort are as far as possible relieved. If the infant happens |
to get an infection, the kind of infection that in a normal |
infant would be swiftly cleared up with antibiotics, no antibiotics |
are given. Since the survival of the infant is not desired, no steps |
are taken to prevent a condition, easily curable by ordinary |
medical techniques, proving fatal. |
All this is, as I have said, accepted medical practice. In articles |
in medical journals, doctors have described cases in which they |
have allowed infants to die. These cases are not limited to spina |
bifida, but include, for instance, babies born with Down's syndrome |
and other complications. In 1982, the 'Baby Doe' case |
brought this practice to the attention of the American public. |
'Baby Doe' was the legal pseudonym of a baby born in Bloomington, |
Indiana, with Down's syndrome and some additional |
problems. The most serious of these was that the passage from |
the mouth to the stomach - the oesophagus - was not properly |
formed. This meant that Baby Doe could not receive nourishment |
by mouth. The problem could have been repaired by surgery |
- but in this case the parents, after discussing the situation |
with their obstetrician, refused permission for surgery. Without |
surgery, Baby Doe would soon die. Baby Doe's father later said |
203 |
Practical Ethics |
that as a schoolteacher he had worked closely with Down's |
syndrome children, and that he and his wife had decided that |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.