BioethicsBioethicsSummer 2005 University of TorontoSummer 2005 University of Toronto

Prof. Kirstin BorgersonProf. Kirstin Borgersonkirstin@chass.utoronto.cakirstin@chass.utoronto.caRoom Room 359S359S Munk Centre Munk Centre

Office Hours: Tuesday 3-5pm and by Office Hours: Tuesday 3-5pm and by appointmentappointment

Review/PreviewReview/Preview Course specifics:Course specifics:

Website and notes: www.chass.utoronto.ca/~kirstinWebsite and notes: www.chass.utoronto.ca/~kirstin Lecture format: Lecture format:

Monday 6:10-7:15 [break] 7:30-8:30Monday 6:10-7:15 [break] 7:30-8:30 Wednesday 6:10-7 [break] 7:10-8Wednesday 6:10-7 [break] 7:10-8

Midterm Exam (returned July 13 in tutorial)Midterm Exam (returned July 13 in tutorial) Essay (topic: July 13, due: July 27)Essay (topic: July 13, due: July 27) Final Exam (week of Aug. 15-19)Final Exam (week of Aug. 15-19) Tutorials (continue) Tutorials (continue) Office hours and *location 359S*Office hours and *location 359S*

Structure of the course – Hippocratic OathStructure of the course – Hippocratic Oath

Methodology: reflective Methodology: reflective equilibriumequilibrium

TheoriesTheories

PrinciplesPrinciples

Specific CasesSpecific Cases

SuicideSuicide Lecture 1 Outline:Lecture 1 Outline:

1.1. Suicide – definitionSuicide – definition2.2. Kant’s arguments against suicideKant’s arguments against suicide3.3. Brandt’s pilot caseBrandt’s pilot case4.4. Brandt’s rebuttal of common arguments Brandt’s rebuttal of common arguments

against suicideagainst suicide5.5. Brandt’s arguments against absolute Brandt’s arguments against absolute

prohibition on suicideprohibition on suicide6.6. Moral obligations of othersMoral obligations of others7.7. Implications of a general principle of moral Implications of a general principle of moral

obligations to othersobligations to others

SuicideSuicide

““The intentional termination of one’s The intentional termination of one’s own life” (382)own life” (382)

Can be passive (refusing to eat) or Can be passive (refusing to eat) or active (overdosing on drugs)active (overdosing on drugs)

Are there conditions under which Are there conditions under which suicide is morally justified? Which suicide is morally justified? Which conditions?conditions?

Kant/BrandtKant/Brandt

Deontological position (Kant): Deontological position (Kant): “suicide is in no circumstances “suicide is in no circumstances permissible” (388)permissible” (388)

Utilitarian/Consequentialist position Utilitarian/Consequentialist position (Brandt): “suicide is sometimes (Brandt): “suicide is sometimes morally acceptable” (391)morally acceptable” (391)

KantKant

Recall: an ethics of respect for personsRecall: an ethics of respect for persons

““Act in such a way that you always treat Act in such a way that you always treat humanity, whether in your own person in the humanity, whether in your own person in the person of any other, never simply as a means, person of any other, never simply as a means, but always at the same time as an end” (18)but always at the same time as an end” (18)

““To use life for its own destruction, to use life To use life for its own destruction, to use life for producing lifelessness is self-for producing lifelessness is self-contradictory” (388)contradictory” (388)

KantKant

Irrationality Argument (Self-Irrationality Argument (Self-contradiction)contradiction)

1.1. One’s embodied life is the condition of any choice One’s embodied life is the condition of any choice one makesone makes

2.2. Suicide destroys one’s embodied lifeSuicide destroys one’s embodied life3.3. One’s embodied life is the condition of the suicide One’s embodied life is the condition of the suicide

choice [from 1]choice [from 1]4.4. Suicide destroys the condition of one’s suicide choice Suicide destroys the condition of one’s suicide choice

[from 2,3][from 2,3]5.5. Any choice that destroys the condition of making Any choice that destroys the condition of making

choices is irrational *[Irrationality premise]choices is irrational *[Irrationality premise]6.6. The suicide choice is irrational [from 4,5]The suicide choice is irrational [from 4,5]

KantKant

Focus: The Irrationality PremiseFocus: The Irrationality Premise Example: slavery and freedom (J.S.Mill Example: slavery and freedom (J.S.Mill

On LibertyOn Liberty))

Counter-examples:Counter-examples:1.1. Choice to end choices – Sovereign Texas and Choice to end choices – Sovereign Texas and

USAUSA

2.2. Structure of real contradictions? – “We had Structure of real contradictions? – “We had to destroy the village to save it”, lying to destroy the village to save it”, lying promisespromises

KantKant

Stewardship ArgumentStewardship Argument

1.1. One has the authority to dispose only of that One has the authority to dispose only of that which is one’s ownwhich is one’s own

2.2. One’s embodied life is not one’s own One’s embodied life is not one’s own *[Stewardship premise]*[Stewardship premise]

3.3. One has no authority to dispose of one’s One has no authority to dispose of one’s embodied life [from 1,2]embodied life [from 1,2]

4.4. Suicide disposes of one’s embodied lifeSuicide disposes of one’s embodied life

5.5. One has no authority to commit suicide [from One has no authority to commit suicide [from 3,4]3,4]

KantKant

Focus: The Stewardship PremiseFocus: The Stewardship Premise Reasons for accepting this premise?Reasons for accepting this premise?

Hume’s Objection:Hume’s Objection: ““If my life be not my own, it were criminal for me If my life be not my own, it were criminal for me

to put it in danger, as well as dispose of it: Nor to put it in danger, as well as dispose of it: Nor could one man deserve the appellation of Hero, could one man deserve the appellation of Hero, whom glory or friendship transports into the whom glory or friendship transports into the greatest dangers, and another merit the reproach greatest dangers, and another merit the reproach of Wretch or Miscreant, who puts period to his of Wretch or Miscreant, who puts period to his life, from the same or like motives” [‘Of Suicide’]life, from the same or like motives” [‘Of Suicide’]

Hume’s ObjectionHume’s Objection

In logical form:In logical form:

1.1. If one’s life is not one’s own, then one has no If one’s life is not one’s own, then one has no authority to dispose of one’s life or put it at authority to dispose of one’s life or put it at riskrisk

2.2. If one has no authority to put one’s life at If one has no authority to put one’s life at risk, then heroic action is not permissiblerisk, then heroic action is not permissible

3.3. Heroic action is permissibleHeroic action is permissible

4.4. Therefore, one’s life is one’s ownTherefore, one’s life is one’s own

Kant’s ReplyKant’s Reply

““We must draw a distinction between a We must draw a distinction between a suicide and a victim of fate…[w]hat suicide and a victim of fate…[w]hat constitutes suicide is the intention to constitutes suicide is the intention to destroy oneself” (389)destroy oneself” (389)

You are a You are a victim of fatevictim of fate if, had you been if, had you been given another option, you would have given another option, you would have taken it. taken it. Example: soldier throwing himself on live Example: soldier throwing himself on live

grenadegrenade

Doctrine of Double EffectDoctrine of Double Effect

““Sometimes it is permissible to bring about as a Sometimes it is permissible to bring about as a merely foreseen side effect a harmful event that it merely foreseen side effect a harmful event that it would be impermissible to bring about intentionally” would be impermissible to bring about intentionally” – – Stanford Encyclopedia of PhilosophyStanford Encyclopedia of Philosophy

Foresee / Intend (the consequences of an action)Foresee / Intend (the consequences of an action)

Aquinas: “Nothing hinders one act from having two Aquinas: “Nothing hinders one act from having two effects, only one of which is intended, while the effects, only one of which is intended, while the other is beside the intention. … Accordingly, the act other is beside the intention. … Accordingly, the act of self-defense may have two effects: one, the saving of self-defense may have two effects: one, the saving of one's life; the other, the slaying of the aggressor.” of one's life; the other, the slaying of the aggressor.” – – Stanford Encyclopedia of PhilosophyStanford Encyclopedia of Philosophy

Kant’s Reply (continued)Kant’s Reply (continued) Recall: Suicide is “the intentional termination Recall: Suicide is “the intentional termination

of one’s own life”of one’s own life” What constitutes ‘intent’?What constitutes ‘intent’?

For Kant, intent includes the final objective of For Kant, intent includes the final objective of the actthe act Soldier/grenade example…Soldier/grenade example…

So the final objective of the soldier is So the final objective of the soldier is notnot to to kill himself – therefore, for Kant, the soldier kill himself – therefore, for Kant, the soldier does not have the (real) intent to die and his does not have the (real) intent to die and his death is death is notnot a case of suicide… and his self- a case of suicide… and his self-sacrifice sacrifice isis morally permissible because it is morally permissible because it is consistent with a respect for personsconsistent with a respect for persons

Brandt’s Pilot CaseBrandt’s Pilot Case

Brandt’s Pilot CaseBrandt’s Pilot Case

BrandtBrandt Option 1: stay in the plane, bring it down Option 1: stay in the plane, bring it down

where it will do little damage - at the cost where it will do little damage - at the cost of certain death for himselfof certain death for himself

Option 2: bail out of the plane, let it fall Option 2: bail out of the plane, let it fall where it will (very possibly killing a good where it will (very possibly killing a good number of people) - he survivesnumber of people) - he survives

Option 1 looks like it isOption 1 looks like it is suicide suicide AND AND morally permissiblemorally permissible

How would Kant respond?How would Kant respond?

IntentionIntention Kant: this is not an act of suicide, but rather of Kant: this is not an act of suicide, but rather of

self-sacrificeself-sacrifice Why? Why? IntentionIntention

Brandt disagrees with Kant’s interpretation of Brandt disagrees with Kant’s interpretation of intention. In ordinary language, the soldier intention. In ordinary language, the soldier who throws himself on the grenade or the who throws himself on the grenade or the pilot who dies to save innocent lives on the pilot who dies to save innocent lives on the ground appear to ground appear to intendintend their death. They are their death. They are 100% sure they will die if they perform the 100% sure they will die if they perform the action, and they knowingly choose to do so action, and they knowingly choose to do so when other options are available. That they when other options are available. That they might have preferred to choose other actions might have preferred to choose other actions is beside the point.is beside the point.

Understanding BrandtUnderstanding Brandt

Why does Brandt have this account Why does Brandt have this account of intention?of intention?

Recall that Brandt, as a Utilitarian, Recall that Brandt, as a Utilitarian, is a consequentialist.is a consequentialist.

Doctrine of double effect and Doctrine of double effect and consequentialismconsequentialism

Brandt – 3 Common Brandt – 3 Common Arguments Against SuicideArguments Against Suicide

1.1. Theological ArgumentsTheological Arguments

2.2. Natural Law ArgumentsNatural Law Arguments

3.3. Social Harm ArgumentsSocial Harm Arguments

1. Theological 1. Theological ArgumentsArguments

A. St. Augustine, 6A. St. Augustine, 6thth Commandment Commandment

Modern Messages – New Modern Messages – New Orleans 1998Orleans 1998

Brandt’s ObjectionsBrandt’s Objections God prohibits suicide and we are bound God prohibits suicide and we are bound

by divine commandby divine command

Objection 1: “arbitrary exegesis” (392)Objection 1: “arbitrary exegesis” (392)

Objection 2: “If there is not some Objection 2: “If there is not some consideration which shows on the merits consideration which shows on the merits of the case that suicide is morally wrong, of the case that suicide is morally wrong, God had no business prohibiting it”God had no business prohibiting it”

Brandt & EuthyphroBrandt & Euthyphro The central question is: "Is the pious loved The central question is: "Is the pious loved

by the gods because it is pious, or is it pious by the gods because it is pious, or is it pious because it is loved by the gods? (because it is loved by the gods? (EuthyphroEuthyphro, , 10) 10)

So.. Is suicide bad because God forbids it?So.. Is suicide bad because God forbids it? Or does God forbid suicide because it is bad?Or does God forbid suicide because it is bad? Reasons for doubting the former optionReasons for doubting the former option Brandt (and Kant!) believes the latter – Brandt (and Kant!) believes the latter –

therefore we can access the reasons why it therefore we can access the reasons why it is bad and analyze themis bad and analyze them

2. Natural Law Argument2. Natural Law Argument

St. Thomas St. Thomas (Aquinas): (Aquinas): ““Wherefore suicide Wherefore suicide

is contrary to the is contrary to the inclination of inclination of nature…[it] is nature…[it] is always a mortal always a mortal sin.” (393)sin.” (393)

Brandt’s ObjectionsBrandt’s Objections Objection 1: Humans are not always Objection 1: Humans are not always

morally bound to do what they have morally bound to do what they have ‘natural inclination’ to do ‘natural inclination’ to do

(Natural/Moral come apart)(Natural/Moral come apart) Examples: Chastity Examples: Chastity Violence/Aggression?Violence/Aggression? Adultery?Adultery? Addiction?Addiction?

Brandt’s ObjectionsBrandt’s Objections

Objection 2: Some people do have a Objection 2: Some people do have a strong ‘natural inclination’ to diestrong ‘natural inclination’ to die

““It is as natural for a human being to It is as natural for a human being to dislike, and to take steps to avoid, say, dislike, and to take steps to avoid, say, great pain, as it is to cling to life” (393)great pain, as it is to cling to life” (393)

3. Social Harm 3. Social Harm ArgumentsArguments

Aristotle and othersAristotle and others ““Suicide does harm to other persons, Suicide does harm to other persons,

or to society at large” (393)or to society at large” (393) Harm to the community/society from Harm to the community/society from

the loss of one personthe loss of one person Think of family members,Think of family members,

friends, colleagues…friends, colleagues…

Brandt’s ObjectionBrandt’s Objection (From Hume)(From Hume) We’re not all FreudWe’re not all Freud ““But surely there have been many suicides But surely there have been many suicides

whose demise was not a noticeable loss to whose demise was not a noticeable loss to society; an honest man could only say that in society; an honest man could only say that in some instances society was better off without some instances society was better off without them” (394)them” (394)

Sometimes suicide does harm others, but Sometimes suicide does harm others, but sometimes it does not. Absolute prohibition is sometimes it does not. Absolute prohibition is unwarranted.unwarranted.

Example: suicide of terminally ill – family not Example: suicide of terminally ill – family not harmed (perhaps even benefited)harmed (perhaps even benefited)

Brandt’s ConclusionsBrandt’s Conclusions Absolute prohibition on suicide is unjustified (even Absolute prohibition on suicide is unjustified (even

‘absurd’) - there are some instances of morally ‘absurd’) - there are some instances of morally justifiable suicidejustifiable suicide

Some moral obligation to avoid suicide (which may be Some moral obligation to avoid suicide (which may be overridden) could be justified by Utilitarian calculusoverridden) could be justified by Utilitarian calculus

IF it is the case that a general prohibition on suicide IF it is the case that a general prohibition on suicide would maximize utility THENwould maximize utility THEN

Mould the conceptual and motivational structure of Mould the conceptual and motivational structure of persons so that they avoid suicide (feelings of guilt, persons so that they avoid suicide (feelings of guilt, disapproval)disapproval)

Prevents many ‘fit of passion’ suicides (anger, Prevents many ‘fit of passion’ suicides (anger, jealousy) but allows for deliberation which would jealousy) but allows for deliberation which would allow those persons whose welfare is best served by allow those persons whose welfare is best served by suicide to proceedsuicide to proceed

Rationality and SuicideRationality and Suicide A person contemplating suicide chooses A person contemplating suicide chooses

between future ‘world-courses’between future ‘world-courses’ Choose the best/most rational world Choose the best/most rational world

course by asking what a person would course by asking what a person would choose with all information taken into choose with all information taken into account account

Time indifference – allow for Time indifference – allow for desire/preference changes in the futuredesire/preference changes in the future

Acknowledged uncertainty, but all life Acknowledged uncertainty, but all life choices are based on probabilities anyway choices are based on probabilities anyway

‘‘Clear beyond a reasonable doubt’ Clear beyond a reasonable doubt’

Depression and Depression and RationalityRationality

Rational weighing of future life-courses Rational weighing of future life-courses (judgment) may be insidiously influenced by (judgment) may be insidiously influenced by depressiondepression

Also ‘goal-gradient’ phenomenon (difficulty Also ‘goal-gradient’ phenomenon (difficulty with time indifference)with time indifference)

Brandt is concerned about these influencesBrandt is concerned about these influences

Considers the role of other persons in dealing Considers the role of other persons in dealing with these problemswith these problems

Brandt and the Role of Brandt and the Role of Other PersonsOther Persons

““What is the moral obligation of other What is the moral obligation of other persons toward those who are persons toward those who are contemplating suicide?” (397)contemplating suicide?” (397)

If there is such an obligation, it would be If there is such an obligation, it would be “an instance of the more general “an instance of the more general obligation to render aid to those in serious obligation to render aid to those in serious distress, at least when this can be done at distress, at least when this can be done at no great cost to one’s self” (397)no great cost to one’s self” (397)

Moral Obligations to Others Moral Obligations to Others – The Pond Case– The Pond Case

Thought Thought experiment to experiment to motivate the motivate the principle – child in principle – child in the ornamental the ornamental pondpond

Obligations to OthersObligations to Others

Peter Singer’s ‘comparable moral Peter Singer’s ‘comparable moral significance’ principle:significance’ principle:

““If it is in our power to prevent If it is in our power to prevent something very bad from happening something very bad from happening without thereby sacrificing anything without thereby sacrificing anything of comparable moral significance, we of comparable moral significance, we ought to do it." (ought to do it." (Practical Ethics, Practical Ethics, 277)277)

Implications for BrandtImplications for Brandt

Brandt easily gets his ‘moral obligations Brandt easily gets his ‘moral obligations to assist those in distress’ from this to assist those in distress’ from this general principlegeneral principle Assistance determining rationality of suicideAssistance determining rationality of suicide Assistance in getting care if not rationalAssistance in getting care if not rational Assistance in suicide if rationalAssistance in suicide if rational

There are also broad social implications There are also broad social implications of this moral principleof this moral principle

Broad ImplicationsBroad Implications

Implications - PovertyImplications - Poverty Relative poverty – when people are poor relative to the wealth Relative poverty – when people are poor relative to the wealth

of othersof others Absolute poverty – poverty by any standardAbsolute poverty – poverty by any standard

““the lack of sufficient income in cash or kind to meet the most the lack of sufficient income in cash or kind to meet the most basic needs for food, clothing and shelter” (Singer, 220) = 23% of basic needs for food, clothing and shelter” (Singer, 220) = 23% of the world’s populationthe world’s population

Approx. 400 million people lack the calories, protein, vitamins Approx. 400 million people lack the calories, protein, vitamins and minerals to sustain their bodies and minds in a healthy and minerals to sustain their bodies and minds in a healthy statestate

14 million children under five die each year from the 14 million children under five die each year from the combined effects of malnutrition and infectioncombined effects of malnutrition and infection

The rate of death from hunger-related diseases is equivalent The rate of death from hunger-related diseases is equivalent to approximately 300 jumbo jet crashes per DAY with no to approximately 300 jumbo jet crashes per DAY with no survivors (and half the passengers are children)survivors (and half the passengers are children)

Death and disease aside, the quality of life for those who Death and disease aside, the quality of life for those who survive is very low (‘miserable’) – inadequate food, shelter, survive is very low (‘miserable’) – inadequate food, shelter, clothing, sanitation, health services and educationclothing, sanitation, health services and education

Rich/Poor Gap and Moral Rich/Poor Gap and Moral Obligations to OthersObligations to Others

Wealthiest 1/5Wealthiest 1/5thth of the of the population controls 85% of population controls 85% of the global incomethe global income

Poorest 1/5Poorest 1/5thth of the of the population controls 1.4% population controls 1.4% of the global incomeof the global income

Britain’s richest 10 people have as much wealth Britain’s richest 10 people have as much wealth as 23 countries with over 174 million peopleas 23 countries with over 174 million people

Broad Implications of the Broad Implications of the Obligation to AssistObligation to Assist

Logical Structure:Logical Structure:1.1. If we can prevent something bad without If we can prevent something bad without

sacrificing anything of comparable [moral] sacrificing anything of comparable [moral] significance, we ought to do it [principle]significance, we ought to do it [principle]

2.2. Absolute poverty is bad Absolute poverty is bad

3.3. There is some absolute poverty we can There is some absolute poverty we can prevent without sacrificing anything of prevent without sacrificing anything of comparable moral significancecomparable moral significance

4.4. We ought to prevent some absolute poverty We ought to prevent some absolute poverty [from 1,2,3][from 1,2,3]

DiscussionDiscussion

Problems with the argument? Problems with the argument? Does this conflict with any other Does this conflict with any other

moral intuitions we have? (Use moral intuitions we have? (Use reflective equilibrium…)reflective equilibrium…)

The motorcycle accident vs. the The motorcycle accident vs. the envelope (Peter Unger)envelope (Peter Unger)

Are we (the ‘absolutely affluent’) Are we (the ‘absolutely affluent’) moral?moral?

SummarySummary

Suicide – “the intentional termination of Suicide – “the intentional termination of one’s own life”one’s own life”

1.1. Suicide – definitionSuicide – definition2.2. Kant’s arguments against suicideKant’s arguments against suicide3.3. Brandt’s pilot caseBrandt’s pilot case4.4. Brandt’s rebuttal of common arguments Brandt’s rebuttal of common arguments

against suicideagainst suicide5.5. Brandt’s arguments against absolute Brandt’s arguments against absolute

prohibition on suicideprohibition on suicide6.6. Moral obligations of othersMoral obligations of others7.7. Implications of a general principle of moral Implications of a general principle of moral

obligations to othersobligations to others

Next ClassNext Class

Morality of suicide as it arises in the Morality of suicide as it arises in the medical context. Special case:medical context. Special case: EuthanasiaEuthanasia

And next Monday: Physician-Assisted And next Monday: Physician-Assisted SuicideSuicide

ContactContactProf. Kirstin BorgersonProf. Kirstin Borgerson

Room Room 359S359S Munk Centre for Munk Centre for International Studies International Studies

Office Hours: Tuesday 3-5pmOffice Hours: Tuesday 3-5pmCourse Website: Course Website:

www.chass.utoronto.ca/~kirstinwww.chass.utoronto.ca/~kirstin