An Ethical Analysis of Medical Suicide
Using Utilitarian Philosophy OF JOHN STUART MILL
Introduction
Everyone will die; this is an inescapable fact of
our fallen world. Our physical bodies will cease to work either through
injury or disease. Medical technology has provided many advances in
treating diseases and repairing the injuries. These medical advances
have given our society a quality of life better than in previous
generations as well as providing the expectation of living longer. But,
the fundamental outcome remains, we will still die. This is where we
reach the ethical problem. When the medical practitioners have reached
the limits of technology and there is nothing that can be done, the
person will die. So, what is the next course of action left for the
dying person? This paper will focus on the issue of a person choosing
to end their life with the help of a doctor rather than of the natural
process using the philosophical ideas of John Stuart Mill and
utilitarianism.
This paper will only consider the situation certain
type of situation. A person has been diagnosed with a terminal illness,
such as cancer or tumor and the disease will continue to grow and spread
throughout their body. This process is usually gradual but not always.
At first, normal activities are limited but as the disease spreads, more
and more of the person’s activities are curtailed. At some point the
person would no longer be capable of caring for themselves and will
require assistance in meeting basic bodily needs. It is usually at this
stage of their disease is when the patient will start to think and talk
about ending their life.
Highlights of Utilitarian Philosophy
The fundamental cornerstone of the utilitarian
philosophy for Mill is finding the “Greatest Happiness Principle” (GHP).
“Happiness” here means intended pleasure or the absence of pain and
“unhappiness” means pain or the absence of pleasure. The utility is, as
Mill calls it, in gaining the maximum happiness and minimizing
non-happiness or pain. The argument goes like this: Happiness is to be
maximized. What brings happiness? Pleasure, so we should strife to find
the things that are pleasurable in life. This is not just the
gathering of pleasure in any form (which is known hedonism), because
Mill says there are constraints on this gathering of pleasure by saying
that it is not the quantity of pleasure but the quality of pleasure.
Our pleasures are based in lower physical or higher intellectual
pursuits.
Mill uses pigs as examples, the pig is taking care of his needs and is
satisfied but has no idea about other facets of life that the rational
beings have. Hence, it is better to be an unhappy Socrates than a
totally happy pig. A different way to look at this is to maximize the
higher order pleasures. Do not settle for finding any pleasure but find
the greater pleasure that will appeal to the rational part of the
intellect. Another big issue for Mill is motivation verses intention.
Under his thinking intention is the major factor for moral action. For
example, saving the drowning person is done with the intention of saving
them from certain death. But the motives for doing it, duty, hope of
reward, etc., do not play into the intent of the action.
This is a very brief and overly simplified view of utilitarian
philosophy.
The Analysis
The basic arguments that have been
used by proponents of medical suicide are usually based on Mill’s GHP.
As a rational being, a person needs to pursue the higher pleasures to
gain the greater happiness. When the crippling and debilitating disease
takes hold, they are not longer able to take part in the higher
pleasures. Just existing is all that is available to them. Many regard
this as a loss of personal dignity with this lost being paramount to the
losing life itself. So, ending this existence would be a good thing
according to the utilitarian followers.
Along this line, if the person was
in great pain but for the most part they are still able to go about
their normal activities. They still have their dignity intact, so to
speak. But the ravages of pain were very apparent to those around
them. Many feel the compassionate course of action would be to allow
the suffering person to end their pain, their suffering. In this case,
the justification would be to follow the GHP and end their life.
Another argument that is used by the
suffering person is that they want to spare their loved ones the
suffering of watching them die. This argument has its roots in the GPH
because of the desire to minimize the pain of loss for others. Usually,
there is also an economic aspect of this argument as well. Medical care
is expensive and a prolong hospital stay, nursing care, and drugs can
drain a family’s assets very quickly. So the person with the illness
sees ending of their life as a means to save their loved ones emotional
and economic suffering of a protracted illness.
These situations may have some merit
under the general understanding of utilitarianism. But Mill had this to
say about this situation:
To those who have neither public nor private
affections, the excitements of life are much curtailed, and in any case
dwindle in value as the time approaches when all selfish interests must
be terminated by death: while those who leave after them objects of
personal affection, and especially those who have also cultivated a
fellow-feeling with the collective interests of mankind, retain as
lively an interest in life on the eve of death as in the vigor of youth
and health. Next to selfishness, the principal cause which makes life
unsatisfactory is want of mental cultivation.
This quote
has been interpreted in many ways by people striving to support their
point of view on medical suicides. Like the situations previously
stated, suicide is considered a viable method to handle these
situations.
Then others have used this same idea to support their argument that
suicides under these conditions are the same as murder or at the very
least manslaughter.
The specific act of suicide was not mentioned by Mill and by not doing
so has left the idea open to interpretation. However, he clearly values
the human interaction and the need for mental stimulation as part of
living and not just during the aging and/or dying process.
Furthermore, he admonished Novalis
for his view that a suicide can be a recommended course of action.
In an
analysis of Mill’s life and works,
Barbara Gates states that at various times of his life Mill suffered
from bouts of depression, lingering melancholy and even a couple of
nervous break downs. It is thought that these mental health issues were
directly related to issues with his father. Seemingly, this should have
been a factor for him to support suicide as a means to end these
difficulties. However, he does not do that at all. In “On Liberty”
Mill states selling one’s self into slavery would be contrary to basic
human desires. Gates states that this argument could have been
logically be extended to self-murder or suicide but he does not do so.
This fact and his admonishment of Novalis, she states that in Mill’s
mind, suicide undermines utilitarianism.
The Great Utilitarian Experiment of Oregon
Many observers were shocked when
voters in Oregon passed the Death with Dignity Act. This new law
legalized physician assist suicide for terminally ill patients. The
primary arguments used to get this legislation passed were ones of
kindness, compassion, and utilitarianism. Sullivan reported in the New
England Journal
that getting firm data was difficult because of the privacy and secrecy
of the Act. But, the team found 27 cases of physician assisted suicide
in 1999. Approximately, 21 of the patients fit the model that had been
used to get the law pass. These were patients in the latter stages of
their diseases and were in a great deal of pain. Their decision to end
their lives was made with their primary care physician that had been
treating them all along. However, the remaining 6 patients case
bothered the researchers. These patients were in the very early stages
of their diseases and clearly not suffering. They had each gone doctor
shopping after their diagnosis to find a doctor to assist them in
dying. Their reasons usually centered on stress and the potential loss
of independence not the debilitating agony of the final stage of a
painful disease. Clearly, this was not what Oregonian voters had
intended. They had envisioned a great act of compassion for a dying
individual being added by a physician that is an old friend and
confidant. Instead, what sometimes happens is an excuse to avoid the
difficulties and unpleasantness of life from a cold and impersonal
killing machine.
Conclusion
The popular belief is that
utilitarianism would support the suicide of a terminally ill person
and the experience of Oregon voters has perpetuated this idea. However,
the analysis has shown the following: Mill’s regarded for human
interaction and mental stimulation is a necessary for part of life. He
admonished Novalis for his glorification of suicide. Furthermore, he
did not take the personal freedom argument one step further to include
suicide. Therefore, John Stuart Mill would not have supported such an
action as being ethical under the philosophy of utilitarianism.
BIBLIOGRAPHY
Gates, Barbara T. "Victorian Suicide: Mad
Crimes and Sad Histories, Chapter Two: Willing To Be." Victorian Web,
1989.
http://www.victorianweb.org/books/suicide/02.html.
(accessed November 30, 2007).
Mill, J. S., edited by Roger Crisp.
Utilitarianism. Oxford: Oxford University Press, 1998.
Smith, Wesley J. "Assisted Suicide: The Tip Of
The Iceberg." BNET Research Center, Spring 1999.
http://findarticles.com/p/articles/mi_qa3798/is_199904/ai_n8837331/
(accessed November 30, 2007).
Sullivan, Amy D., Katrina Hedberg, David W.
Fleming. "Legalized Physician-Assisted Suicide in Oregon - The Second
Year." New England Journal of Medicine 342 (Febuary 24 2000):
589-604.
Unknown. "Euthanasia: Comparing Kantian and
Utilitarian Ideas." Free Essay, October 29, 2004.
http://www.echeat.com/essay.php?t=25608/
(accessed November 30, 2007).
