Assisted Suicide and Euthanasia

A Natural Law Ethics Approach

Craig Paterson

• Publisher: Routledge
• Year: 2017
• Print ISBN:
  9780754657460
• eBook ISBN:
  9781351575072
• Topic: Philosophy
• Subtopic: Philosophy History & Theory

As medical technology advances and severely injured or ill people can be kept alive and functioning long beyond what was previously medically possible, the debate surrounding the ethics of end-of-life care and quality-of-life issues has grown more urgent.In this lucid and vigorous new book, Craig Paterson discusses assisted suicide and euthanasia from a fully fledged but non-dogmatic secular natural law perspective. He rehabilitates and revitalises the natural law approach to moral reasoning by developing a pluralistic account of just why we are required by practical rationality to respect and not violate key demands generated by the primary goods of persons, especially human life.Important issues that shape the moral quality of an action are explained and analysed: intention/foresight; action/omission; action/consequences; killing/letting die; innocence/non-innocence; and, person/non-person. Paterson defends the central normative proposition that 'it is always a serious moral wrong to intentionally kill an innocent human person, whether self or another, notwithstanding any further appeal to consequences or motive'.

Chapter 1
Introduction

1.1 Contemporary Debate

Controversy pervades contemporary debate over the moral and legal status of assisted suicide and euthanasia. If you were asked to compile a top-ten list of hotly contested moral issues, it’s a safe guess that assisted suicide and euthanasia would feature prominently on your list. The passionate nature of the current debate and the spirited activities of pressure groups in the UK and US who support or oppose these practices, help ensure that the topic will not disappear from the public spotlight.

If proof were really needed to substantiate the claim that ethical debate over the status of assisted suicide and euthanasia is very intense, to make good the claim I need only draw the reader’s attention to two recent high profile legal examples. In the UK, we have seen a flurry of public debate over the voting decision of the House of Lords to block a private member’s bill that would have granted terminally ill patients the legal right to avail themselves of assisted suicide, overturning a 1961 statute that currently prohibits the practice. In the US, within the last year or so, we have also witnessed intense media discussion concerning the status of Oregon’s physician-assisted suicide statute, and the decision of the US Supreme Court in January 2006 to strike down a former US Attorney-General’s attempt to use a federal drug control statute to circumvent the legality of assisted suicide.

The topic has already generated a good deal of scholarly and popular writing, especially after 1984, the watershed event being the Dutch Supreme Court’s decision to permit the Netherlands to become the first Western country to give legal sanction to some forms of assisted suicide and euthanasia. Given this body of writing, the reader might well question the need for another book on the topic. What can I expect to add to the nature of the debate that has not already been said? In reply, let me state that I decided to put pen to paper and write a book on the topic because I perceived a gap in the literature that needed to be addressed—an accessible treatise opposing assisted suicide and euthanasia written from a secular natural law ethics perspective. The more I delved into the available literature, the more I increasingly began to think that my own ethical position on the moral and legal status of assisted suicide and euthanasia was not being well enough articulated or defended. The kind of natural law approach often encountered in the thrust of contemporary debate, I surmised, was either overtly religious in nature or implicitly traded on revealed theological doctrine (so-called ‘baptised reason’¹). This did not accord well with my own understanding of how a publicly accessible natural law approach should be explained and defended. When faced with the reality of pluralism in contemporary society, I especially thought that the rationale for adopting a natural law approach to moral discourse stood in need of stronger justification.

The reality of pluralism fatally challenges the assumption that we can make ready appeal to the common values of Judaeo-Christian heritage in order to provide us with the shared moral underpinnings for social life together. Further, some think the reality of pluralism fatally undermines any possible appeal to substantive reasoning about goods in order to determine what constitutes the ‘good life’ for persons. While this second challenge also runs deep, I am convinced that the secular natural law approach I seek to defend in this book can effectively respond to it. My approach, broadly, seeks to demonstrate how a ‘polyteleological’ notion of the ‘good life’—a pluralistic ‘good lives’ approach—is able to provide a secular framework for shared social life together but is nevertheless decidedly guarded in its grounds for justifying the state use of coercive power over moral questions (roughly, only where the human conduct in question can be seen to clearly imperil compelling goods that the state has a paramount interest to protect and foster).

Since I am aware that ‘natural law ethics’ may not be an ethical and political approach familiar to the reader (or familiar only in religious or quasi-religious guise), I first turn to the task of sketching out, by way of initial orientation, some useful structural distinctions. Subsequent chapters will endeavor to ‘flesh out’ the shape of my revised ‘non-natural’ approach to natural law ethics. After completing this task, I then turn to address some significant questions of scope and meaning concerning the terms ‘suicide,’ ‘assisted suicide,’ and ‘euthanasia.’ Since use of these terms is not unproblematic, it will be helpful to indicate to the reader where I stand on questions of use. Lastly, I will conclude this introductory chapter with a brief conspectus highlighting the subsequent chapter by chapter arrangement of the book.

1.2 Natural Law Ethics

‘Natural law’ is a phrase that is apt to be misunderstood or misinterpreted in different ways, especially given its long and varied history.² Part of the problem is that there is no single theory or thinker that constitutes the ‘core’ of natural law thought, although the influence of Aquinas’s work is often considered central by many who would consider themselves natural law ethicists. Space, alas, will not permit the production of a comprehensive taxonomy of the different kinds of natural law theory. I must instead content myself with the task of mentioning some necessary broad brush distinctions with a view to explaining where I am structurally positioned viz. my own revised approach to natural law ethics.

1.2a Moral Law not Law of Nature

Moral natural law should not to be confused with ‘the law of nature,’ in the scientific sense of that expression. Laws of nature describe how physical entities act. Laws of nature are descriptive not prescriptive. These uniformities or regularities simply are. Physical entities do not ‘deliberate’ on how they behave; they do not choose to act or not according to laws of nature. Natural law, on the other hand, is concerned with how rational human beings ought to act, and here the key ingredients of human deliberation and choice are crucial. The word ‘ought’ in that last sentence is important. Human beings have minds and wills capable of reasoned deliberation and choice. We are not bound to behave in a way that a mere physical entity has no choice but to behave (although since ‘ought implies can,’ as Immanuel Kant pointed out, laws of nature certainly place logical and physical limitations on the powers we have to deliberate and will).³

All forms of natural law are concerned with how human beings are obligated to act in the world if their willed acts are to conform to the requirements of objectively determined moral standards. Natural law, then, is to be understood as a normative law of reason, not as a law describing a force of physical necessity that autonomically compels all of our actions.

1.2b Secular not Religious

Natural law has become marginalized in the eyes of many due to its perceived dependency on the sources of revealed religion. Revelation and faith are ‘privileged sources of information’ that cannot be said to function in an open and publicly accessible manner. Natural law is thought to be a kind of ‘cloaking device’ used in order to ‘conceal’ the imposition of divine moral imperatives on secular society. I am the first to admit that many varieties of natural law are in fact religious accounts and use the inspiration of divine imperatives as explicit or implied premises in their argumentative strategies. It often seems as if these accounts would be better labeled ‘supernatural law’ ethics rather than natural law ethics. As my argument unfolds, however, it will become clear why I argue that such an assessment of my revised natural law approach would be unwarranted. My revised approach is secularly grounded. When I say secular I mean that reason cannot be based on appeals to any form of knowledge other than natural human knowledge. Centered on our natural human ability to reason, I seek to argue how a secular natural law approach can credibly claim to be a genuine source of ethical knowledge that is open and (in principle) accessible to all. The structure of my approach will not depend upon any prior acceptance of the truth of God’s existence or upon anything obtained from special privileged sources of information.

While secularism is often thought of as a notion falling under the near exclusive province of liberal thought, I would contend that there is nothing inherent in the notion of secularism that renders it an exclusively liberal concept, for its ethical significance reaches beyond divisions of political philosophy. Liberal thinkers like John Rawls stress that ‘respect for persons’ must take the ‘fact of pluralism’ seriously and that we fail in our duties of respect if this crucial fact is sidelined from our ethical and political thinking.⁴ I am in basic agreement that respectful consideration of persons cannot be satisfied by justifying coercive legal restraints on the basis of appeal to thick religious doctrine or to complex and highly abstract lines of metaphysical argumentation quite untethered to any sense of bedrock intuition. Restraints on human conduct, if they are to have justification, must instead be substantiated by appeals to publicly accessible reason. As will become clear, however, where I take issue with Rawls and others is over the question of just what constitutes, under conditions of pluralism, a secular publicly accessible reason capable of justifying and setting limits on certain kinds of human conduct. I challenge some of the limiting mechanisms used to determine just what secular arguments can legitimately be included within the scope of ‘publicly reasonable’ discourse. For the moment it is sufficient for me to recognize and accept the significance of a plea for secularism as a general condition for inclusion in the ball-park of publicly reasonable discourse.

1.2c Objectivist not Subjectivist

Natural law is rightly classified as an ‘objectivist’ approach to ethics because it defends the tenet that there is discernible truth to be had in morality—truth that we are all, in principle, able to grasp and appreciate. More exactly, moral truth is held to be grounded in the teleological appeal of humanly fulfilling goods. These goods are understood to be the objective and foundational value sources for the subsequent operation of human reason to work out questions of the good and the right in human conduct.

It is important to bear in mind that natural law stands in basic opposition to the ‘subjectivist’ position that ethics is simply a matter of expressing our personal feelings about moral opinions. The subjectivist holds that there is no objective truth to be discerned in moral discourse. Thus, when we say that an act is evil—for example, the involuntary euthanasia of an elderly person—we are not stating an objective moral truth; we are simply saying that we have negative feelings towards the execution of such an action.

Commitment to objectivism is central to all varieties of natural law.⁵ This emphasis allows us to identify a significant though not exclusive condition that helps make a moral theory a natural law theory, namely, the insistence that moral principles are discernible by reason and are held to be objectively valid. Although natural law differs in some of its elements from other forms of ethical theory, for example, Kantian ethics, natural law at least shares a joint commitment with Kantian ethics that objectively valid principles are to be our guide when discerning how to make moral judgments, not the subjective state of our emotions. Moral judgments and the prescriptions that relate to them are not to be regarded as mere statements of approval or disapproval but rather as truth statements concerning the knowable structure and content of morality.

‘Conventionalism’ is a related view to subjectivism which considers ethical utterances to represent the shared attitudes of a number of persons in a given culture or society. In opposition to conventionalism, all varieties of natural law subscribe to some form of ‘universalism,’ the claim that certain basic ethical truths (primary moral principles) are held to be universally valid because they are knowable and applicable to all people (in all societies; at all times) by virtue of their common shared human capacity to reason about the good and the right. Thus, what may be right or just according to the prevalent standards of a given community or society, for example, Dutch acceptance of euthanasia, may still be radically at odds with objectively discernable moral standards.

If natural law transcends current variations in culture, it also transcends variations in culture over time. Slavery is an objective moral evil that is not simply true of contemporary Western society. It has always been objectively wrong no matter how prevalent the view once was that slavery was a morally acceptable practice. Natural law as ‘natural’ is trans-historical as well as trans-cultural.⁶

Later chapters will attempt to convince the reader just why sound ethical judgments are objectively grounded and not simply the product of subjective feeling (no matter how powerful) or convention (no matter how widespread). In particular, I will seek to explain how my revised natural law approach is capable of establishing the necessary groundwork for an objective morality that: (a) identifies primary and non-primary goods; (b) generates requirements for choosing reasonably in relation to them; and (c) gives rise to a negative moral norm that rules out the intentional killing of all innocent persons (regardless of whether or not the killing is held to be of the ‘consensual kind’).

1.2d Perfectionist not Anti-Perfectionist

Natural law is an approach to normativity rooted in the idea of ‘perfectionism’—the view that morality and politics ought to promote excellence of well-being in both the individual and in society at large. The general idea of perfectionism, pursuit of virtue, is also common to all varieties of natural law. Perfectionism is not merely about the individual pursuing his or her quest to instantiate excellence of virtue in his or her own life. It also represents the notion that political and societal institutions should also be concerned with the ends of promoting virtue in order to advance the common good of society.⁷

Natural law contends that morality, politics and law are ultimately concerned with...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface and Acknowledgments
• 1 Introduction
• 2 Justifications for Suicide, Assisted Suicide and Euthanasia
• 3 A Revised Natural Law Ethics
• 4 The Good of Human Life
• 5 Suicide, Assisted Suicide and Voluntary Euthanasia
• 6 Non-voluntary and Involuntary Euthanasia
• 7 State Intervention and the Common Good
• Bibliography
• Index