The right thing to do james rachels pdf

James Rachels wrote The End of Life: Euthanasia and Morality (1986). Here he defends the “argument from mercy.” Euthanasia, he thinks, is justified when death is the only way to escape awful pain. In Rachels’ main example, the pain is suffered by someone dying from cancer.

Rachels himself died of cancer in 2003. At the end of his life, nothing persuaded him to change his view of euthanasia. But he did wonder whether the argument from mercy would require less intentional killing than he had thought. Often a humane death occurs via “permanent sedation.” This is when a dying patient is given more and more pain medication for pain relief, which causes the patient to lose consciousness (or “go to sleep”) before dying. Under such circumstances, the intention to kill is unnecessary.

The single most powerful argument in support of euthanasia is the argument from mercy. It is also an exceptionally simple argument, at least in its main idea, which makes one uncomplicated point. Termi- nally ill patients sometimes suffer pain so horrible that it is beyond the comprehension of those who have not actually experienced it. Their suffering can be so terrible that we do not even like to read about it or

Chapter 33

The Morality of Euthanasia James Rachels

James Rachels, “The Morality of Euthanasia” in Philosophy and Public Affairs, vol. 1, no. 1 (autumn 1971): 47–66. Used with permission.

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The Right Thing to Do : Readings in Moral Philosophy, edited by James Rachels, and Stuart Rachels, Rowman & Littlefield Publishers, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/newschoolarch-ebooks/detail.action?docID=5798603. Created from newschoolarch-ebooks on 2020-05-14 19:24:15.

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think about it; we recoil even from the description of such agony. The argument from mercy says euthanasia is justified because it provides an end to that.

The great Irish satirist Jonathan Swift took eight years to die, while, in the words of Joseph Fletcher, “His mind crumbled to pieces.” At times the pain in his blinded eyes was so intense he had to be restrained from tearing them out with his own hands. Knives and other potential instruments of suicide had to be kept from him. For the last three years of his life, he could do nothing but sit and drool; and when he finally died it was only after convulsions that lasted thirty-six hours.

Swift died in 1745. Since then, doctors have learned how to eliminate much of the pain that accompanies terminal illness, but the victory has been far from complete. So, here is a more modern example.

Stewart Alsop was a respected journalist who died in 1975 of a rare form of cancer. Before he died, he wrote movingly of his experiences as a terminal patient. Although he had not thought much about euthanasia before, he came to approve of it after rooming briefly with someone he called Jack:

The third night that I roomed with Jack in our tiny double room in the solid-tumor ward of the cancer clinic of the National Institutes of Health in Bethesda, Md., a terrible thought occurred to me.

Jack had a melanoma in his belly, a malignant solid tumor that the doctors guessed was about the size of a softball. The cancer had started a few months before with a small tumor in his left shoulder, and there had been several operations since. The doctors planned to remove the softball-sized tumor, but they knew Jack would soon die. The cancer had metastasized—it had spread beyond control.

Jack was good-looking, about 28, and brave. He was in constant pain, and his doctor had prescribed an intravenous shot of a synthetic opiate—a pain-killer, or analgesic—every four hours. His wife spent many of the daylight hours with him, and she would sit or lie on his bed and pat him all over, as one pats a child, only more methodically, and this seemed to help control the pain. But at night, when his pretty wife had left (wives cannot stay overnight at the NIH clinic) and darkness fell, the pain would attack without pity.

At the prescribed hour, a nurse would give Jack a shot of the synthetic analgesic, and this would control the pain for perhaps two hours or a bit more. Then he would begin to moan, or whimper, very low, as though he didn’t want to wake me. Then he would begin to howl, like a dog.

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The Right Thing to Do : Readings in Moral Philosophy, edited by James Rachels, and Stuart Rachels, Rowman & Littlefield Publishers, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/newschoolarch-ebooks/detail.action?docID=5798603. Created from newschoolarch-ebooks on 2020-05-14 19:24:15.

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The Morality of Euthanasia 371

When this happened, either he or I would ring for a nurse, and ask for a pain-killer. She would give him some codeine or the like by mouth, but it never did any real good—it affected him no more than half an aspirin might affect a man who had just broken his arm. Always the nurse would explain as encouragingly as she could that there was not long to go before the next intravenous shot—“Only about 50 minutes now.” And always poor Jack’s whimpers and howls would become more loud and frequent until at last the blessed relief came.

The third night of this routine, the terrible thought occurred to me. “If Jack were a dog,” I thought, “what would be done with him?” The answer was obvious: the pound, and chloroform. No human being with a spark of pity could let a living thing suffer so, to no good end.

The NIH clinic is, of course, one of the most modern and best-equipped hospitals we have. Jack’s suffering was not the result of poor treatment in some backward rural facility; it was the inevitable product of his disease, which medical science was powerless to prevent.

I have quoted Alsop at length not for the sake of indulging in gory details but to give a clear idea of the kind of suffering we are talking about. We should not gloss over these facts with euphemistic language or squeamishly avert our eyes from them. For only by keeping them firmly and vividly in mind can we appreciate the full force of the argu- ment from mercy: If a person prefers—and even begs for—death as the only alternative to lingering on in this kind of torment, only to die anyway after a while, then surely it is not immoral to help this person die sooner. As Alsop put it, “No human being with a spark of pity could let a living thing suffer so, to no good end.”

THE UTILITARIAN VERSION OF THE ARGUMENT

In connection with this argument, the utilitarians deserve special men- tion. They argued that actions and social policies should be judged right or wrong exclusively according to whether they cause happiness or misery; and they argued that when judged by this standard, euthanasia turns out to be morally acceptable. The utilitarian argument may be elaborated as follows:

(1) Any action or social policy is morally right if it serves to increase the amount of happiness in the world or to decrease the amount of

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misery. Conversely, an action or social policy is morally wrong if it serves to decrease happiness or to increase misery.

(2) The policy of killing, at their own request, hopelessly ill patients who are suffering great pain would decrease the amount of misery in the world. (An example could be Alsop’s friend Jack.)

(3) Therefore, such a policy would be morally right.

The first premise of this argument, (1), states the Principle of Util- ity, which is the basic utilitarian assumption. Today most philosophers think that this principle is wrong, because they think that the promo- tion of happiness and the avoidance of misery are not the only morally important things. Happiness, they say, is only one among many values that should be promoted: freedom, justice, and a respect for people’s rights are also important. To take one example: people might be hap- pier if there were no freedom of religion, for if everyone adhered to the same religious beliefs, there would be greater harmony among people. There would be no unhappiness caused within families by Jewish girls marrying Catholic boys, and so forth. Moreover, if people were brain- washed well enough, no one would mind not having freedom of choice. Thus happiness would be increased. But, the argument continues, even if happiness could be increased this way, it would not be right to deny people freedom of religion, because people have a right to make their own choices. Therefore, the first premise of the utilitarian argument is unacceptable.

There is a related difficulty for utilitarianism, which connects more directly with the topic of euthanasia. Suppose a person is leading a miserable life—a life containing more unhappiness than happiness— but does not want to die. This person thinks that a miserable life is better than none at all. Now I assume that we would all agree that the person should not be killed; that would be plain, unjustifiable murder. Yet it would decrease the amount of misery in the world if we killed this person—it would lead to an increase in the balance of happiness over unhappiness—and so it is hard to see how, on strictly utilitarian grounds, it could be wrong. Again, the Principle of Utility seems to be an inadequate guide for determining right and wrong. So we are on shaky ground if we rely on this version of the argument from mercy for a defense of euthanasia.

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The Morality of Euthanasia 373

DOING WHAT IS IN EVERYONE’S BEST INTERESTS

Although the foregoing utilitarian argument is faulty, it is nevertheless based on a sound idea. For even if the promotion of happiness and avoidance of misery are not the only morally important things, they are still very important. So, when an action or a social policy would decrease misery, that is a very strong reason in its favor. In the cases of voluntary euthanasia we are now considering, great suffering is elimi- nated, and since the patient requests it, there is no question of violat- ing individual rights. That is why, regardless of the difficulties of the Principle of Utility, the utilitarian version of the argument still retains considerable force.

I want now to present a somewhat different version of the argument from mercy, which is inspired by utilitarianism but which avoids the difficulties of the foregoing version by not making the Principle of Util- ity a premise of the argument. I believe that the following argument is sound and proves that euthanasia can be justified:

(1) If an action promotes the best interests of everyone concerned and violates no one’s rights, then that action is morally acceptable.

(2) In at least some cases, active euthanasia promotes the best interests of everyone concerned and violates no one’s rights.

(3) Therefore, in at least some cases, active euthanasia is morally acceptable.

It would have been in everyone’s best interests if active euthanasia had been employed in the case of Stewart Alsop’s friend Jack. First, and most important, it would have been in Jack’s own interests, since it would have provided him with an easier, better death, without pain. (Who among us would choose Jack’s death, if we had a choice, rather than a quick painless death?) Second, it would have been in the best interests of Jack’s wife. Her misery, helplessly watching him suffer, must have been almost unbearable. Third, the hospital staff’s best inter- ests would have been served, since if Jack’s dying had not been pro- longed, they could have turned their attention to other patients whom they could have helped. Fourth, other patients would have benefited,

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Chapter 33374

since medical resources would no longer have been used in the sad, pointless maintenance of Jack’s physical existence. Finally, if Jack him- self requested to be killed, the act would not have violated his rights. Considering all this, how can active euthanasia in this case be wrong? How can it be wrong to do an action that is merciful, that benefits every- one concerned, and that violates no one’s rights?

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