Euthanasia and the permissibility of moral debate

One should, in general, be able to discuss controversial moral topics without it being assumed that you support the worst possible consequences of the topic under debate. I add the “in general” because it’s rather difficult to imagine someone arguing in good faith when they ask that we debate whether one race is superior to the next, or some similarly prejudiced proposition.

And, there’s a distinction worth retaining between stating that something is right or wrong, and having sympathy for someone who is placed in the position of having to make a difficult or controversial moral choice – whether or not that person ends up making the choice that you’d make, or hope that they would have made.

Recently, a public representative of a large South African political party posted a tweet regarding how difficult it is to imagine the “strength and courage Tania Clarence had to euthanise her children”. Her choice of words was poor, in that “strength and courage” can easily be read to imply a positive judgement on the action itself – but I think it fairly clear that the tweet was intended to signal sympathy for Clarence, who made a choice that we should all hope we’re never in a position to entertain.

That choice was to end the lives of her three children, two 3 year-old sons and a 4 year-old daughter. If you think euthanasia impermissible, or a euphemism for murder, you’d (rightly, on your view) condemn this as murder. But if you think that there are situations in which ending a life is permissible, you’d (rightly, on your view) want to discuss whether this case falls into the “permissible” set or not.

It’s no good to simply assert that euthanasia is always murder, as conclusions are not (or shouldn’t be) persausive – arguments are. And the argument that euthanasia is always impermissible is in my view a weak one, as I regard cases like Tony Nicklinson’s as a clear example of a situation in which euthanasia is not only permissible, but the morally correct decision.

Nicklinson was an adult who had expressed his wish to die, and this is one clear difference between his case and that of the Clarence children. Informed consent is easier to obtain in a case like Nicklinson’s, despite the extreme difficulties he had with communicating. One might want, as a point of principle, to insist that euthanasia is only ever permissible with the consent of the person who is to die – Belgium has done this, [as has the Netherlands] for children over the age of 12.

In the case of the Clarence children, informed consent is unlikely to impossible, even if some version of weak consent is possible. So if consent is required, one might think that euthanasia is (or, was) morally impermissible in their case. But that still wouldn’t make Tania Clarence a monster – she might still have been doing what she thought best for her children, even if she was wrong, and even if her husband resents the choice she ended up making.

Why might she have thought it the correct choice? Because, she might have foreseen a life of unendurable suffering for her children, despite the fact that many sufferers of type 2 spinal muscular atrophy (SMA) go on to raise families, have full lives and so forth. Many also don’t, and the ones that do are no argument against the fact that their chances of reaching middle-age are small, and their chances of great suffering fairly large.

So, one can imagine cases where a decision like Clarence’s is a cop-out. A painful cop-out, to be sure, but nonetheless, a capitulation in the face of the demands made on her as a mother, both emotionally in terms of watching her children suffer, and in terms of the resources that would be required to raise three disabled children.

But one can also imagine cases in which there is a significant degree of medical consensus that a child, or three children, will suffer enormously and live very short and unrewarding lives. The twins in this case “needed to have medication hourly, were tube fed and incapable of independent movement“, and weakness with SMA increases over time. Each case is different, and each case would no doubt be enormously difficult – but such cases would surely exist, and in such cases, you’d be more sympathetic to Clarence’s choice, and you might even think it morally permissible (regardless of what is legal).

Even if you think it’s never morally permissible to end a life – whether that of a non-human animal, a child or an adult – persuading people of this requires that they hear your arguments, and they won’t hear those arguments if you simply yell “eugenics” and “Hitler” at them, or if you take your case of SMA as representative of the whole.

As I said at the top, the “strength and courage” Tweet created the wrong impression, and led to some sustained abuse towards the person who tweeted it. My response was to say

and I’ll stick with that, even though I’m now getting a fair amount of abuse myself. Nobody’s mind will be changed through lazy caricatures of their arguments, or through asserting contrary conclusions as if they are fact. These are difficult issues, which means that we should expect the arguments to be difficult also.

22 Replies to “Euthanasia and the permissibility of moral debate”

  1. I’ll start with a factual correction. You say in this article that Belgium allows voluntary euthanasia for children over the age of 12. Since February 2014, Belgium has allowed voluntary euthanasia of children of any age, as you said yourself in your article of 15 Feb 2014. It is the Netherlands that only legally allows it for children over the age of 12. (Having said that, under the Groningen Protocol, babies with spina bifida and related conditions are regularly being killed in the Netherlands, despite the fact that it is technically illegal.)

    Now on to your opinion piece. You say that we should be able to discuss controversial moral topics without it being assumed that you support the worst possible consequences of the topic under debate. In general. And then you clarify that “in general” means that you get to exclude the arguments that you personally consider beyond the pale.

    Right there in the first paragraph, you effectively admit to having a double standard. You have your own line that you draw, where you say that beyond this, some arguments just shouldn’t be entertained. Then, when other people have their own lines – lines that will inevitably differ in position from yours – you complain about it. That’s not a rationally defensible position to take. To be consistent, either have your line and accept that other people have theirs, or have no line at all.

    I’m not going to accuse you of not arguing in good faith, and I’m not going to assume that you support the worst possible consequences of an acceptance of euthanasia. However, neither of those questions is relevant to what the consequences will be. Whether or not your arguing is “in good faith” is something internal to your mind. Your words are the same either way, and the effect on the world is determined by the words that come out, not by the hidden intention behind them. And the consequences that follow from your words will follow whether or not you “support” those consequences. You don’t get to choose how your words will be taken by others. So you are – whether intentionally or not – focusing on irrelevancies.

    If someone says that somebody has shown “strength and courage” by doing something, any native speaker of English is going to read that as an assertion not only that an act has been undertaken with intent (trial? what trial?) but that those who hold back from performing such an act might be doing so out of weakness or cowardice. Whether that’s what she intended or not is irrelevant. (If it is not what she intended, then she is quite spectacularly bad at expressing herself and should perhaps consider giving up politics, lest she should accidentally declare war over dinner while asking for the salt.) So never mind what her intention was, or what consequences she wanted. What will the consequences actually be, if her words are taken seriously?

    The only possible consequences that I can think of are horrifying. Clearly her words would offer encouragement to anyone who is contemplating a similar act. Somebody who is now, or who may be in the future, in the frame of mind in which they are considering killing their own children might remember the warm and fuzzy sentiment about “strength and courage” and feel just that little bit more encouraged to go through with it. And that’s just about the least horrifying of the possible consequences. More horrifying still, people with degrees in philosophy might actually defend her statement, decision-makers might be encouraged by what they might see as a stamp of approval from academia, and legislation might be altered to make it easier for people to kill their disabled children. Perhaps that doesn’t bother you. But it distresses many disabled people and those who care about them, and it will do a lot worse to the children who would actually go on to be killed.

    The troubling thing about euthanasia is that there are no good consequences to taking it seriously. You say, “Tania Clarence […] might still have been doing what she thought best for her children”. But let’s be rational about this. We’re talking about permanently ending their very existence. How can that be what is best? How can it be an improvement over their prior condition? If you kill someone, they are not going to thank you for it, or say, “Yes, I feel a lot better now.” They won’t feel at rest. Even if they felt that they were suffering beforehand, they are not going to feel any respite from that by being plunged into oblivion. If anyone ever says that someone will be “better off dead”, then they are simply wrong – nobody should feel reticent about saying so – and they are spreading a dangerous idea that can only lead to more deaths. And in the present context, that is specifically the deaths of disabled people. I don’t think the comparisons with Nazis are entirely unjustified.

    People don’t like to see death for what it is. They’ve always made up stories to make it seem more palatable. They might talk of an afterlife, or of reincarnation, and people take comfort from the idea that death is somehow just a continuation of life. People in the modern secular world are not immune from the same need for comfort. People will still express the desire for a suffering individual to be “at peace”, as if the dead person were still there, in a state of serenity much like sleep. You can take out the explicit references to religious elements, but if you still think of death as a state of being which can be qualitatively compared with the state of living – and that can furthermore be “better” than it – then the same underlying irrationality is still there.

    1. Your comment assumes things I haven’t said, I’m afraid, and reveals an uncharitable disposition as early as paragraph 3 (in which you also contradict your own – previously accurate, in paragraph 2 – reading of my words). I never say these things shouldn’t be discussed. My blog is precisely about how they should be discussed. And I’ve never complained about other people drawing the line in a different place to where I do, so the accusations of a double-standard and inconsistency are unfounded.

      As I say in the post itself, I agree with what you present as the likely interpretation of the tweet the MP posted.

      People do have different views. My post is about how we should be able to debate and discuss those views, and not simply be shouted down. Your comment – besides the opening paragraphs – demonstrates that this is indeed the case, so thank you for that,

  2. Jaques, you state in your introduction that “it’s rather difficult to imagine someone arguing in good faith when they ask that we debate whether one race is superior to the next”. I see this issue as identical to that argument, or at least similar in a very crucial way. If this mother had killed three healthy children, she would have been seen as a demon – like any other child killer. The only difference is that these particular children were disabled. So the sympathy, or discussion around her motives, stems purely from the assumption that the lives of three disabled children are somehow less valuable than the lives of three non-disabled children. Imagine if the difference had been race, rather than disability?

    As soon as we start making that distinction we are on extremely dangerous territory. How disabled does a child have to be before it’s OK for him or her to be killed? I suggest there isn’t a line – it is never acceptable to kill a child (or adult for that matter) because they are disabled.
    If we were to agree that the life of a disabled child is every bit as valuable and precious and important as the life of a non-disabled child, this discussion wouldn’t even be happening. So, clearly, we don’t. Which is frightening.
    I understand it must be exhausting to look after three young children with such demanding needs. But of the options available to her, killing them would never be an acceptable outcome.

    1. As you say in your second-last paragraph, we clearly have a more fundamental difference of views than simply the disabled or not issue – you think that life is in and of itself valuable, and I don’t. But that shouldn’t stop you from seeing what I’m saying, even if if you think it morally repugnant – the point of a killing like this might, in the mind of the person who does it, be motivated precisely because they care about the wellbeing of the person in question, and think that they are better off not-existing anymore.

      1. I think that’s my point Jaques. The assumption, on someone else’s behalf, that their life is not worth living purely because they are disabled. Either life is valuable for all or for no-one. To make the decision that life is less valuable for someone who is disabled is an unbelievable view for those disabled people who live our own lives without someone else deciding on our behalf whether or not we should live.

        If we are saying that “it’s different” for these children because they were disabled, are we saying that “it’s different” for all disabled people because their lives are somehow less worth living?

        1. It’s not “different” for disabled children – the distinction is between lives worth living and lives not worth living, for whatever reason (extreme poverty, depression, etc.). A second issue is whether that distinction can ever be made, whether it’s always going to be arbitrary or unprincipled, whether anyone has the right to make it at all.

          1. Surely the only person who has the right to decide whether their life is worth living is the person themselves? Many adults with the same condition those children had are living happy fulfilling productive lives. No-one has the right to take that opportunity away from them. An adult choosing to take their own life is a completely separate matter – we all have that right.

            Look at the adults with SMA – should we think it would be better if someone had put them out of their misery as children? The very idea is unthinkable. No-one knows what futures those three children had in store. But they had a basic fundamental right to find out for themselves whether they thought life was worth living. No-one should take that right away.
            I don’t believe any person has the right to make the choice on behalf of someone else whether or not that life is worth living. There are people with locked-in syndrome who choose to remain alive. The only person who should have the right to end a life is the person themselves, once they reach adulthood and can make informed choices. Almost all disabled adults choose to live, including those needing 24 hour care. No-one should have made the decision to end their lives whilst they were still children.

            1. I understand that you hold that view, but please bear in mind that this is nevertheless related to “live’ topics in moral philosophy and attendant debate (most recently reinvigorated by the Giubilini and Minerva paper on abortion & infanticide, and going back many decades before that). My post simply argues that these debates can be had – and that if your view is the correct one, the best way to make that the default position for everyone is for the debate to be had, rather than for dissenting voices to be shouted down.

  3. Choosing death for others is always difficult. And it should always remain a complicated medical decision. When the persons for whom death is being chosen are children, the case becomes even more difficult. But in some cases, we must nevertheless choose. You can find this chapter on the Internet: “Safeguards for Making Life-Ending Decisions for Children”: http://www.tc.umn.edu/~parkx032/CY-CHILD.html.

    1. There is never a reason to “choose death for others”. Palliative care until death occurs is the only thing which should be permitted.

  4. Jacques, what do you know about disability? How many disabled friends do you socialise with? How many diaabled students do you have? How many disabled colleagues?

    We grow up & dwell in a world where bigotry towards disabled people is endemic. None of us are immune to the time & place we inhabit. Even most young or newly disabled people go through a period of finding it hard to identify as disabled. This is because the impression we have of disability is so negative, that we can’t see ourselves that way. The impression is false. But it is this negative impression of us that able-bodied society clings to & propagates. Pathetic recipients of charity; monstrous sci-fi bad guys; people segregated from “normal” people “for our own good”. It is virtually impossible to find images of disabled people which don’t make disability seem something horrible to be feared & which don’t make disabled people seem subhuman, “other” & objects of disgust.

    You consider debate on whether one race is superior to another is not in good faith, because it is based on prejudice. Any discussion of killing people on grounds of disability is similarly prejudiced. And, if discussing spurious ideas about racial superiority is dangerous, how much more dangerous is it to discuss the actual killing of another despised & identifiable minority group?

    1. I agree entirely that there is a widespread prejudice against disabled people. And as a philosopher, my attitude towards eliminating that (as any) prejudice is more debate, not less.

      1. No reasonable person would think discussion of cases for & against slavery or genocide was a debate which should be had. The only reason the killing of disabled people is still a live topic within philosophy is because bigotry towards disabled people is still acceptable is a way that racism isn’t.

  5. Let me first state where we agree. I think the more calm and rational discussion of the issue, the better. But I also think that, distasteful as it is to me, we should also be able to discuss whether one race is superior to the next. Free speech is indivisible; we may not pick and choose who should have it according to our own inclinations.

    I also agree that there are some situations where euthanasia is appropriate. I am thinking of the “policeman’s dilemma” whereby a policeman comes across a trucker stuck in his burning cab with no hope of escape. He begs the policeman to shoot him. Does the policeman overcome his aversion of killing in order to prevent suffering? Yes – and doctors often take what can only be construed as compassionate actions to prevent needless suffering in the last hours, days or weeks of a life (about 3k times per year in the UK)..

    Where you are wrong, I feel, is that, though we might have some sympathy for the mother, her action was clearly wrong. Moreover, it was murder or, at best, manslaughter. Even those in the the situations I described above might be charged with murder, though other considerations make these actions right. The whole prescription against killing is based on an implicit value placed upon every human life. People are upset with Santosh Kalyan because she implied that murder was in fact euthanasia, that the children were better off dead. Their lives not being worth living because of their disability, Kalyan asserts, renders the taking of their lives justifiable.

    We do not distinguish in law between the killing of a twenty-year old and an eighty-nine year old terminally-ill person. Both lives are of equal value before the law and the taking of them (within the contexts within which these deaths occur) equally wrong. But what Kalyan implies is that, because of their disabilities, the mother’s actions had “strength and courage” ie these deaths were beneficial to society.

    Think of it another way. If a mother killed her child because it had been fathered by a black man – let us say that she really believed that blacks were inferior and that her children had bleak prospects (she might back this up with socio-economic statistics) – would it be offensive to label this clearly racial crime understandable and “a good death” rather than murder?

    1. Kevin, I don’t say we should not be able to discuss whether one race is superior to another. So, we don’t disagree there. Second, I never say that the mother’s action in this case was right, so you can’t say I was wrong in saying that (“that” being something I don’t say).

      1. On the first – I’m glad! On the second point, you are not sitting on the fence – you defend Santosh Kalyan and you entertain the idea that the mother killed her children because of their disabilities and not because of her struggle but because her childrens’ lives might have had suffering and been short. Blacks live shorter and poorer lives – would you similarly defend killing mixed-race children because their prospects are not as good as if they were white? If not, what’s the difference, other than your judgment that people with certain disabilities lead inferior lives?

        1. On the second point, I’m not sitting on the fence, because I have not expressed a view. I defend Kalyan from abuse – not defend her view, while giving suggestions as to what her motivation might have been. I’ve used the case to explore the issues more generally, as a way to argue – simply, and exclusively – that it does no good to shout at someone and call them names instead of debating the issues.

          As to your thought-experiment – I can’t imagine a situation in our current world in which the life of a black person would be sufficiently miserable (qua their being black) that would outweigh the moral wrong of killing them. I can imagine situations in which suffering (whether that of a disabled person, a non-disabled person, or a non-person) could outweigh the wrong of killing them.

          1. Your views of the suffering of disabled people are informed by ignorance and prejudice due to the extreme segregation of disabled people in your country. And the term “non-person” is as fascist as it gets. Who gets to decide which people qualify as people & which don’t? Deciding that some groups of human beings are subhuman & unworthy of life has been done before. It had appalling consequences, remember?
            I begin to think that South Africa, while it has been forced to confront its bigotry about race, has not examined the wider fascism of the culture which embraced such astonishing levels of racism.
            By the way, some religious extremists would gladly murder their offspring for being gay. If Sandy Kalyan had said that such an act took “strength and courage”, would you be defending her. And would you say that the murder of people on the grounds of their sexuality “merits debate”? I suspect not. And, if racism & homophobia are never good things, why is disablism? (Known as ableism in the US, should you wish to read up.)

            1. You should try being a little more deliberate/thoughful, and less knee-jerk judgemental. Non-persons refers to creatures like my delightful cat, Mogwai, but you apparently don’t think non-human animals worthy of moral consideration. You’re also deeply uninformed about South Africa, and are behaving sufficiently troll-ish that I shall no longer be responding to you.

            2. I am more informed about South Africa than you are about disabled people. I can even count a South African as a dear friend. But he is a retired doctor, Jewish & chose to leave South Africa over 40 years ago so, I think, is rather untypical.

              I apologise for assuming that, by “non-person”, you meant anyone human. I have been reading about Peter Singer recently & am horrified by his attitude.

              I too have a beloved cat & attempt to allow him to be true to his nature by having a catflap & by not chastising him for normal feline behaviour, such as hunting.

              I suppose anyone who disagrees with one heartily & relentlessly could be called a troll, although I feel that is rather harsh, considering that I haven’t been particularly personal. I can’t help wondering if you are hiding behind my trollishness to avoid answering my question about murdering on grounds of sexual orientation…

              Btw, are you aware of your countryman Vic Finkelstein – one of the great pioneers of the disability rights movement?

              http://www.theguardian.com/society/2011/dec/22/vic-finkelstein

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