Leading a Worthy Life by Leon R. Kass

Author:Leon R. Kass
Language: eng
Format: epub
ISBN: 9781594039423
Publisher: Encounter Books
Published: 2017-11-02T04:00:00+00:00

Bad Consequences

Although the heart of my argument will turn on my understanding of the special meaning of professing the art of healing, I begin with a more familiar mode of ethical analysis: assessing needs and benefits versus dangers and harms. Still the best discussion of this topic is a now classic essay written by Yale Kamisar in 1958.24 Kamisar makes vivid the difficulties of ensuring that the choice for death will be freely made and adequately informed, the problems of physician error and abuse, the troubles for human relationships within families and between doctors and patients, the difficulty of preserving the boundary between voluntary and involuntary euthanasia, and the risks to the whole social order from weakening the absolute prohibition against taking innocent life. These considerations alone are, in my view, sufficient to rebut any attempt to weaken the taboo against medical killing; their relative importance for determining public policy far exceeds their relative importance in this essay. But here they serve also to point us to more profound reasons why doctors must not kill.

There is no question that fortune deals many people a very bad hand, not least at the end of life. All of us, I am sure, know or have known individuals whose last weeks, months, or even years were racked with pain and discomfort, degraded by dependency or loss of self-control, or who lived in such reduced humanity that it cast a deep shadow over their entire lives, especially as remembered by the survivors. All who love them would wish to spare them such an end, and there is no doubt that an earlier death could do it. Against such a clear benefit, attested by many a poignant and heartrending true story, it is difficult to argue, especially when the arguments are necessarily general and seemingly abstract. Still, in the aggregate, the adverse consequences of being governed solely by mercy and compassion may far outweigh the aggregate benefits of trying to relieve agonal or terminal distress by direct medical killing.

The first difficulty emerges when we try to gauge the so-called “need” or demand for medically assisted killing. This question is partly empirical, but evidence can be gathered only if the relevant categories of “euthanizable” people are clearly defined. Such definition is notoriously hard to accomplish – and it is not always honestly attempted. On careful inspection, we discover that if the category is precisely defined, the need for mercy killing or assisted suicide seems to be greatly exaggerated, and if the category is loosely defined, the poisoners will be working overtime.

The category always mentioned first to justify mercy killing or assisted suicide is the group of persons suffering from incurable and fatal illnesses, those with intractable pain and little time left to live but still fully aware, who freely request a release from their distress – for example, people rapidly dying from disseminated cancer with bony metastases, unresponsive to chemotherapy. But as experts in pain control tell us, the number of such people with truly untreatable pain is in truth rather low.

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