Acts and Omissions

It is currently far more acceptable to allow instances of passive euthanasia (allowing someone to die by withholding treatment), as compared to active euthanasia (injecting them with a lethal drug that would prematurely end their lives). This is partly linked to our strong inclinations towards the sanctity of life. While many would be squeamish at actively taking a role in causing a death (even if acting on a person's wishes), they are less likely to feel the same way about causing a death in an indirect way (e.g. withholding potential treatment).

This can be clearly seen in the responses to the classic runaway cart scenario. In the scenario, there is a runaway cart hurtling down some tracks. It is currently headed for a group of four workers in the distance, who are too far away to warn and too preoccupied to notice in time to get out of the way. However, you can throw a switch diverting the cart onto a separate set of tracks which would spare the four workers, however, in doing so a single individual would be killed. Most people would find it acceptable to throw the switch.

However, in a separate scenario, the same cart is hurtling towards the same four people, but the only way to stop it is to push a bystander next to you onto the tracks. He happens to be quite a large individual with the bulk necessary to stop the cart. If you throw yourself on the tracks, it would be insufficient to stop the cart entirely and the four workers would still die. In this latter case, most people would not push the person onto the tracks to save the four people. The only fundamental difference is whether you would be directly on indirectly causing the death of one person in saving the four.

So this difference over the direct vs. indirect causation of death is deeply held and can seem to translate to a doctrine of acts and omissions. So I play an active role if I administer an injection or prescribe a cocktail of drugs which the patient then takes (note in this case I am merely giving the patient the means to end their life). A passive role would be to 'let nature take its course' for example by withholding drugs so a patient would die 'naturally' from an illness. Studies have shown that many doctors (and nurses) often carry out the latter for infants with severely deformities, for example, or in prescribing large doses of painkillers that will hasten death but provide some comfort in the case of terminal illnesses. Some nurses even allow very elderly patients in nursing homes to succumb to treatable illnesses such as pneumonia, rather that subject them to intrusive medical care, particularly if that patient has been ill a number of times.

Two classic contrasting examples illustrate our strange understanding of acts and omissions. The first is that of 'Baby Doe', a baby born with severe Down's syndrome, but also an oesophagus that was not fully formed. The baby was thus not able to digest food. An operation could be performed to fully connect the oesophagus which would allow for the normal intake of food but Baby Doe's parents requested that the operation not be performed. The baby died five days later after two courts upheld the parent's request. That the baby could have survived if the operation had been performed is not in doubt, though he would have faced severe mental deficiencies.

Compare this to the case of Samuel Linares, a young toddler that swallowed an object that became lodged in his throat. He was rushed to hospital but suffered severe brain damage due to the lack of oxygen intake to his brain. He was only kept alive by a respirator, and was comatose for over nine months, after which the hospital recommended that he be placed in a long term care unit, as it was unlikely that he would ever regain consciousness. His parents' request that he be taken off the respirator were ignored. Eventually, his father, armed with a pistol, forced his way into the ward and disconnected the respirator personally, cradling Samuel in his arms until the baby died. He then surrendered himself, weeping uncontrollably, to the police.

The two cases are especially illustrative because if both babies had lived, there is little doubt that Baby Doe would have a significantly better quality of life. Given Samuel Linares was in what was effectively a persistent vegetative state, and doctors were unsure if he would ever regain consciousness, it is doubtful if you can say he even had a quality of life at all. (A British High Court Judge made a similar remark when ruling about Anthony Bland, a football fan in a persistent comatose state as a result of the Hillsborough Stadium disaster).

Does it make sense that we allow Baby Doe's parents to effectively consign him to death (by not giving permission for the operation) while refusing to allow Samuel Linares' parents to make a decision allowing for their son to die peacefully by removing the respirator that was sustaining him? If one viewed the respirator as an artificial form of intervention that is sustaining Samuel's life, then one can argue that the parents should have a decision in stating that he should not be put on a respirator in the first place (a rejection of intervention to save life), just as Baby Doe's parents refused the operation (which was a rejection of a life saving intervention). If we agree that both should have the decision, why should we not allow Linares' parents to pull the plug on the respirator, assuming that doctors had done all they could, and it was unknowable and even doubtful if Samuel would ever wake up?

Science as Magic (or Religion)

It was Arthur C. Clarke who proposed, as one of his three 'laws', that a civilisation, coming into contact with science and technology far in advance of them, would view such technology as magic. This idea is hardly a novel one, and anyone who has read the tragic tale of Cortez and his small band of conquistadors overcoming the mighty Aztec empire will clearly see its antecedents. The Aztecs, unable to comprehend Spanish technology such as guns, came to view the conquistadors as reincarnated Gods with predictably disastrous consequences for themselves.

The supposedly opposing poles of Science and Magic has long provided a powerful theme for Science Fiction and Fantasy writers. A pioneer in this, aided by the fact that she was working in both the Science Fiction and Fantasy fields, was Andre Norton, most notably in her Witch World series of novels.

In those novels, a technologically advanced civilisation, fleeing some kind of self-generated catastrophe that has made their homeworld uninhabitable, enters a much more primitive world through a portal, seeking to use their more advanced technology to subjugate the native inhabitants and claim it for their own. However, they are opposed by a matriarchal society whose leaders are witches and able to harness magic (actual magic, not the science in disguise variety).

A new and novel treatment of this ongoing theme is Sharon Shinn's Samaria series of novels, particularly her second novel, Jovah's Angels. In a marvelous twist of irony, she takes the two typically opposing poles of science and mysticism and welds them together in one sure stroke. Our modern scientific way of thinking is perceived to have been borne out of the enlightenment, which involved a total rejection of mysticism and religious dogma. But what if science were the source of mysticism and religion?

In Samaria all beings worship the god Jovah (the parallel with Jehovah is not coincidental). A special group of beings with wings - Angels - are given the task of ensuring society in Samaria is harmonious. These angels can intercede with Jovah by 'praying', for example to change weather patterns, ask for seeds to be sent down and even medical supplies in times of plague or illiness.

However, Jovah also demands obedience from its subjects as any good god would. To prove that the peoples of Samaria still live in harmony, a Gloria must be sung every year led by the Archangel and his Angelica or spouse, with representatives from each of the many races that live on the planet. Three specially appointed prophets 'speak' to Jovah and intercede with him in some long forgotten tongue using some special device.

Shinn's genius is that Jovah is no god but is the computer of the interstellar ship that brought the original colonists to Samaria. The prophets use a simple keyboard to correspond with the God, and the Angels' - beings created through genetic engineering at the dawn of Samarian colonization - prayers are picked up by Jovah's long range sensors where the computer triggers the necessary responses. Control of the weather is enabled through influencing the planet's upper atmosphere, seeds and medicines can be released and dropped from the ship's massive storage hangers, and if the Samarians choose to disobey, the ship's lasers can smite a mighty hole in the planet below.

This is Clarke's third law brought to spectacular life, and Shinn's strong characterization, and utilization of biblical terminology lends the first two books in the series a really strong feel. The implications are strongly felt but neatly sidestepped. Alleluia, despite the realization that everything she believed and worshiped if not quite a lie then is undoubtedly drastically wrong, decides to hide the truth. Samaria cannot know because the implications would be immense - and catastrophic.

Still, given the slow rise of technology (which the original settlers had renounced as being the root of evil), there will eventually come a time when the peoples of Samaria will begin to question the mythology and religion they held so blindly. More fundamentally, it would only take the first telescope pointed up at the Samarian night sky to reveal the orbiting spaceship and raise fundamental questions that will not be left unanswered.

A long running jibe at the irrationality of religion is to posit that there is a giant teacup orbiting the outer edge of the solar system, and that it will eventually bring out the annihilation of the earth. For the people of Samaria, it is a spaceship not a teacup. Perhaps, mankind should not be so quick to laugh, and as we continue to peer out into the darker reaches of our universe, we might just find some hint as to the beginnings of our creation. Now that is a kind of faith in itself.

Euthanasia and Causing Distress

One common argument against euthanasia is the emotional unhappiness to doctors, relatives and friends that such an act would cause. This is of course asserted, and there have been numerous instances of friends and family actually feeling a great deal of relief that their loved ones could die peacefully and without agony at the time of their own choosing. But admittedly, there are also instances (so artfully illustrated in the movie The Sea Inside), where the family members would strongly oppose such a move, and would be greatly distressed by it.

The case is more difficult with regards to doctors. Some doctors in places where euthanasia is legal (or in some cases such as Oregon, assisted suicide) do report emotional distress after their participation in an assisted death, or in prescribing the necessary medication to enable a patient to take their own lives. Others have found it an intrinsic part of what they view as their duty of care to a patient. However, it is reasonable to point out that if it offends a doctor's conscience (or religious beliefs) to assist in such an act, he can pass on the patient's case to another qualified medical practitioner who will be willing to carry out such a patient's wishes.

Let us assume, at the very least, that a patient's decision to take their own lives, at a time of their own choosing (which I deem the basic definition of euthanasia) will cause significant emotional distress to third parties (doctors, nurses, family, friends). Is this justifiable grounds for rejecting a person's request for euthanasia?

Say that a person, who is of sound mind, has decided that by their own assessment, their lives no longer have any value and they wish to die. One classic example would be a quadriplegic who is completely paralyzed from the neck down due to an accident. That person might feel that the loss of the independence and autonomy of his current condition that necessitates him being cared for by others even involving the most basic of needs, means that his life, to him is inherently valueless (or even of negative value) and he thus desires to die. I shall put aside, for now, questions over the person's capacity to make such a decision, and assume that it is a rational decision, not made under the duress of emotional distress or physical pain (though arguably these components make up a vital part of any decision is whether life is worthwhile or even tolerable). There is a demeaning tendency to associate anyone who is considering taking their own lives as being psychologically unsound, which I argue is not necessarily the case.

If we were to deny his request on the grounds of his action causing emotional distress to other people, we would effectively be saying that he should merely be living, not for himself but in due consideration to others. This is something most of us will find inherently odd. Think about a scenario when a somewhat angsty teenager who reads too much philosophy declared to his parents that he had come to the conclusion that his life was fundamentally meaningless and that the only reason why he continues to live was the psychological and emotional anguish that his suicide would cause his parents. If you were his parents you would probably be very disturbed and send him for counseling.

We thus seem to have a deep seated belief that we should have some individual purpose for our lives that is independent of merely living our life for other individuals (I leave aside the question of living for God, which is not anyhow, inherently a person). It thus seems strange that if that same teenager above were completely paralyzed from the neck down, and he told his parents that he found his life completely meaningless and he wished to die, we would tell him that he cannot do so because of the emotional anguish it would cause them and others.

This question of emotional anguish and causing distress relates to one of the fundamental problems facing strict utilitarians (and hedonists) with regards to murder. A strict utilitarian will argue that an action is right so far as it maximizes some ordinal value, usually taken as pleasure. So we should act in such a way as to maximize pleasure and to minimize pain. So according to such a view why is murder inherently wrong? A strict utilitarian could argue that it would cut short any possible future pleasure or happiness that the murdered person could experience.

This view is problematic - first of all it is not at all certain that, on balance, that person would necessarily experience a pleasurable life in the future had he not been murdered. Second of all, there is an inherent problem in committing to maximizing future pleasure. If it is a duty not to kill someone because of the inherent loss of possible future pleasure accrued to that person, will that not imply that we have a corresponding duty to maximize future happiness by creating other individuals that could possibly lead pleasurable lives? So, a couple, if indifferent to having a child (say the pros and cons balance out) on this view must have the baby if the baby will then have a resulting life that is pleasurable.

Strict utilitarians can then appeal to the indirect harmful effects of murder. Murder can lead to other individuals being fearful for their safety, which increases their unhappiness. It causes significant emotional anguish to the murdered individual's friends and family. It can even be argued to disrupt the basic functioning of society. On this view, a strict utilitarian can be said to take the view that the only thing that matters is present pleasure and suffering (of which the potential future pleasure of the murder victim would not count), and still argue against murder. On this view, the only wrong that is committed against the victim by his murderer is the possible pain involved in the ending of his life. Thus seems strange - would killing someone in his sleep through the use of a painless form of poison be any less wrong than stabbing him violently and repeatedly? And worse still, it seems to suggest that murder is wrong only because of the effects it has on society, and the victim's relations, not on the victim itself.

Drawing a parallel with the example at hand. Euthanasia is in effect a decision by an individual to take their own lives - 'self-murder' or bluntly a form of suicide. (The exact differences and similarities between euthanasia and suicide is outside the scope of the current discussion). If, as above we find it hard to accept the notion that murder is inherently wrong due to the indirect harm that it will cause, then it seems inconsistent to apply this same criteria of indirect harm to euthanasia. That is why suicide is no longer illegal in most countries (Singapore being an exception).

Of it can be argued that there is a difference between suicide and assisted suicide. In one case an individual unilaterally (often in distress), takes his or her own life, while in the latter case it usually involves the participation and consent of others, including a qualified medical practitioner. I will not delve into the complex arguments regarding legalizing assisted suicide and/or euthanasia here, but it does seem strange that in a country like Great Britain, you are legally allowed to end your own life by jumping off a building, but you are not allowed to do so by asking a doctor to prescribe you pills that will end you life if you are in a state of severe illness or pain in which otherwise ending your life would be impossible.

An Issue of Equality at Wimbledon

This year's Wimbledon championships are about to begin at the All England Club. The news thus far has centered around the organizers decision to award equal prize money to men and women players, finally caving in to protests and pressure from many of the leading women on tour. They are also introducing the hawkeye system allowing players to challenge line calls after its success at last year's US Open and this year's Australian Open (the system is redundant at the Roland Garros because of ballmarks left on clay).

I can't say that I fully support the decision to award equal prize money (a statement which is liable to provoke the fury of the feminists out there). This stems from my general unease with the feminist movement's attempts to obtain "equality" for women in all areas. To begin with, the very fact remains that the men play best of five set matches and the women play only best of three. So perhaps one could justify the fact that the men were given more prize money by the simple fact that on average, they spent a lot more time on court.

A friend of mine argued that this was an unfair argument to make, given the physical differences between the two sexes. Since men have greater stamina and endurance, it is natural that their matches can go on for longer, and in any professional sport the aim is to test the athletes to their limits which differs for men and women. Once this goal is attained, we should reward both sexes equally.

I accept that in principle, but I can simply point out that we do discriminate based on naturally occurring characteristics. People who are naturally more intelligent tend to get rewarded in society with higher salaries (which come after they get into elite academic institutions that purport to discriminate on intelligence). The great failure of the communist and socialist system was their attempt to apply the principle of equality in a way where everyone was rewarded equally for working to the best of their ability. Nobody is going to remotely reach their maximum potential without some incentive to do so, especially if you are not going to taste the fruits of your additional hard work or talent.

My great uneasiness lies in the fact that the feminist movement has trumped everything with their pressure based on political correctness. It isn't so much a debate on equality anymore insofar as it is one of fairness. It just isn't fair that women earn less than men at Wimbledon because they women are equal to men. To suggest otherwise would be to risk severe social censure. I wonder how fair it is that a small group of individuals have decided that they have a monopoly on determining what is fair and what is not.

Sidenote: A similar debate has surfaced in Golf, with the participation of women in PGA tour events. The Royal and Ancient Golf Club recently amended its regulations allowing for women to take part in the Open Championship if they qualified. Why is it only deemed fair if women have the opportunity to take part in the men's tour (and in their majors such as the Masters and the Open) and decidedly unfair if men were to demand the same for women's events? Perhaps it is because it is perceived that men would have an unfair physical advantage over women at Golf? In other words, that they are unequal?