Friday, March 18, 2011

Further Thoughts on Life Ethics

A comment on my previous post about medical procedures where the death of an unborn child are a side-effect led me to think even more about these topics. I originally responded in the comments thread, but I've decided to make a whole post of it.

In response to my statement that, "I'd admit that, in most women getting abortions, the moral object probably does not involve the death of the child in itself, but merely its removal. But that doesn't mean it's justified[...]it is still equivalent to murder," this poster asked, "What then do you think of the moral object of the abortionist himself, as opposed to the mother??"

I answer: In his case, I think the moral object probably does include the death of the child directly. And so even if the mother herself is indifferent to the baby's death so long as it is removed, she is made an accomplice to murder by the abortionist's moral object.

Because here's my thinking: the mother merely wants the baby removed. She accepts the side-effect of its death for the convenience of not being pregnant, and since this is not an acceptable reason for accepting such a side-effect, that's still unjustifiable homicide even if the death is not directly part of the moral object itself (which makes it a bit better, morally speaking).

But, for the abortionist, the baby's death is directly willed. The ultimate end willed by the abortionist is, say, getting money by fulfilling the woman's desire to remove the baby.

But in the case of the abortionist, the means chosen to fulfill this desire is not merely "removal" indifferent to death. If this were the case, then presumably more abortionists would just deliver babies early but alive. In a partial birth abortion, for example, there is little reason to kill the baby. At that point, all but the head being removed, they could easily birth it live. That they choose not to do so indicates that the death is directly willed by the abortionist, not merely the "removal."

In cases of abortion earlier in pregnancy, it might be argued that death is merely a necessary side-effect of the methods of removal used, but that the abortionist doesn't really will the death, merely the removal. But I think this is disingenuous. If, somehow, the baby did survive the "removal"...does anyone really think the abortionist would be okay with this? At that point, the Born Alive act, for example, would require them to do everything possible to save that child. And it's clear that most would not want to do that.

The mothers mostly seem to simply want to be "not pregnant" but are usually indifferent, beyond that, to whether the removal results in death or not. They likely would be fine with transfer to an artificial womb if such a thing were invented, or with the child being given up for adoption if it survived a late-term abortion. Though, admittedly, some mothers do seem to sadly will not just removing the baby, but also the very idea of it not being alive out there in the world (even if raised by someone else).

The abortionist, however, does not seem ever to choose the child's death merely as an unjustified bad side effect. To the abortionist, it seems, the death is directly willed as the means to fulfilling the woman's desire of removal. Not because "removal" is equivalent to death necessarily, but because the abortionist also doesn't want to deal with the possibility of the baby born/"removed" alive. So abortionists seem to clearly will not just the baby's removal, but then also its death specifically and directly so that they don't have to deal with it alive.

In response to my statement that, "Though every effort should be made, of course, to remove the child (even if death as a side-effect is inevitable) in the manner least painful for him, and most in keeping with his dignity...what I've said about 'removing' for the sake of saving the mother being a different moral object than 'killing' would probably even be true if the means of removal acted directly on the child's body even in a gruesome manner (and Grisez seems to agree)," I was asked, "If, say, the fetus is removed by dismemberment, can we really say that death is merely a 'side effect' of removal. It would seem to me that dismemberment is equivalent to death."

I answer: I'm not so sure. Some things are, definitely, equivalent to killing (like, for example, eating a person; that is simply not conceptually separable from killing them, though eating individual parts of them might be).

As for dismemberment, I'm not sure. As you say, someone could hypothetically be "put back together" and survive dismemberment someday, so it's not necessarily equivalent to death conceptually. Nevertheless, it is definitely equivalent to "harm," which also can never be directly willed as a means or an end (even if it doesn't result in death).

But, I think the answer is that the dismemberment itself is not a directly willed means, but in itself (like the death) only a side effect of "removal." As Grisez (considered a very orthodox theologian, defender of the Church's teachings on contraception, etc) points out:

"The proposal can be simply to alter the child’s physical dimensions and remove him or her because, as a physical object, this body cannot remain where it is without ending in both the baby’s and the mother’s deaths. To understand this proposal, it helps to notice that the baby’s death contributes nothing to the objective sought; indeed, the procedure is exactly the same if the baby has already died."

Dismemberment itself could be seen merely an unintended side effect of "altering the child's physical dimensions" for the sake of removing him. But the fact of removal is not dependent on the dismemberment itself in any morally direct way; if the child's dimensions could be changed merely by a shrink-ray or something, surely they'd do that instead. The dismemberment in itself is not willed as an ends or a means (ie, it is not part of the moral object). Of course, it would have to be justified by some proportionate good (and only saving life could justify something like that).

Some may find this idea distasteful, and it is (these situations are tragic, and not ideal!) but I'll offer an analogy showing why I believe it to be true. Consider an apartment building where the Joker has trapped everyone inside, and a man in the lobby has a small bomb sewn up inside his chest set to go off in a few hours. This man with the bomb has been trapped in a concrete vault with only a small hole, just big enough for a human head to fit through. If anyone tries to break into the walls of the vault, that will set the bomb off immediately. It is also not feasible to pass instruments through the hole expecting to surgically remove just the bomb. The man himself as a whole most be removed.

The end willed in any action is clearly saving the lives of everyone in the building. Furthermore, this is clearly contingent on merely removing the bomb-man from the building, not his death in itself. But, alas, the only way to remove him is to pull him through that tiny hole. That is the means to remove him. Yet he won't fit. In the process, he will surely be torn apart, dismembered. The analogy to certain tough medical situations involving pregnancy is clear.

Nevertheless, the dismemberment (and his resultant death) are only a side-effect of removing him through the hole. It is not willed as a necessary means in itself (the end is not dependent on his dismemberment, if he could be stretched or shrunk or gotten through the hole some other way, that would work equally well). Therefore, it seems to me that dismemberment could legitimately result in such a case as a side-effect of pulling him through the hole, seeing as his removal through it is in itself morally neutral (abstracted from resultant harm) and necessary to achieve the good end of saving the lives. (Though, I'll add, everything should be done to minimize his own pain; likely this would mean drugging him into a state of heavy unconsciousness first).

Finally, and most interesting, was the objection, "Yet by your analysis, we could take organs from a living person (dying themselves or not) in order to save others, because the direct means of our moral object would be merely 'removing the organs,' abstracted from the person's death."

I answer: Grisez gives the following conditions for when it is acceptable to accept the baby's death as a side-effect:

"(i) some pathology threatens the lives of both a pregnant woman and her child, (ii) it is not safe to wait or waiting will surely result in the death of both, (iii) there is no way to save the child, and (iv) an operation that can save the mother’s life will result in the child’s death."

Even, he argues, if this operation physically acts directly on the baby, this is not the same as being a "direct" act on it morally speaking inasmuch as the harm (and death) itself is not willed as an ends or a means.

In the case of organ donation, there are some crucial differences.

One thing that's different is, in organ donation, the two people are not threatened by the self-same condition. Their lives are not "two sides of the same coin" like a mother and baby in a terminal condition that will end up killing both.

Instead, they are dying from different things, and the recipient does not, absolutely speaking, need this donor specifically (nor is the potential donor's death in any way dependent on the death of the potential recipient). Their lives are not bootstrapped one to the other in this regard.

The potential donor could, hypothetically, keep living even if the potential recipient died, and the recipient could keep living even if the donor died (perhaps through a different donor).

This is a significant difference. In cases where the baby could survive perfectly fine without the mother...I do not think it is okay to do a procedure that will result in its death, even as a side effect, even if the baby is coincidentally terminal from some other independent condition. It's only in cases where the choice is between one or both dying together as part of the same causal chain.

This is because it is impermissible to choose one life in favor of another, even if the death were merely a side effect. It would be wrong to do something leading to a baby's death (even just as a side-effect) when it might otherwise survive longer, just in favor of the mother. Human life is, in this sense, of infinite value and cannot be "weighed" like that one against another.

Likewise, it would be impermissible to do something leading to the mother's death (even just as a side-effect) when she might otherwise survive, just in favor of the baby. It's only when it is a question of one or both likely dying together that it is permissible to accept a death as a side-effect.

Some might argue that being passive, that "doing nothing," in some of these cases where it's one or the other (as opposed to one or both together) constitutes an act of choice in itself (either in favor of the baby or the mother, depending on circumstances). That you can't really not choose.

Grisez seems to agree, and so argues not in favor of mere passivity or just "letting nature run its course," but rather, then, choosing whichever intervention seems more likely to save both (even if that seems improbable) or least risky to both.

In most cases, this seems to favor the mother; interventions to save the child at the expense of the mother usually also carry more risk of saving neither (ie, of leading to both dying in the process of the surgery) than simply being passive.

But, in the case of organ donation...I don't think we have a "one or both together" situation intrinsically, as the two lives (and causes of death) are not intrinsically interdependent; the potential donor is not dying from the same thing as the potential recipient like a baby who will necessarily die together with the mother anyway if not removed.

Some might argue that we have a "one or both" situation practically speaking, given that the donor is brain-dead and there is no hope of survival, and that the donor needs his organs (relatively speaking, if not absolutely; like, for example, if he is the only matching donor in the world).

In such a case, I suppose I could "see" the argument that "removing the organs" is not equivalent to "killing" (given that people can survive with organs missing for a time, or with artificial organs), even if the removal becomes the immediate cause of death (as a side-effect) of the already-dying donor. I could at least "see" this argument that, the death of the donor being a foregone conclusion, it's acceptable to hasten it so that at least both don't die.

However, in fact, I don't think this interpretation is correct. Because everyone who is alive can be said to be "already dying." Unless the two deaths are intrinsically bound one to the other like a mother and baby or a paralyzed mountain-climber strapped to a partner (where both will fall if he doesn't cut the paralyzed one loose) still seems to be choosing to accept a death in favor of someone else.

Oh, the death may be likely or "almost certain" or "very near"...but that could be true for anyone. The mother/child situation is different specifically because the baby's death would result because of the mother's death anyway if that death is not prevented. It cannot, however, be said that the potential donor's death results from the potential recipient's death if that death is not prevented.

Therefore, I think that trying to apply the same argument to organ donation (even on "brain dead" living patients)...opens us up to the proposition that even perfectly healthy adults (heck, we're all dying, after all, it's only a matter of degree) could be targeted for "removal of organs" (with death "merely as a side effect" of that) to save other lives. Yet such a side-effect can never be said to be proportional, even to save multiple lives, because human life is non-transferable and of infinite value.

Only in cases where the choice of "one or both (or several)" is due to the fact that the death of the one would result anyway exactly because of the death of the other, where the two things are bootstrapped to each other in such a way as to constitute one event, can such a side-effect ever be accepted.

For a final analogy, consider that there are two people trapped in a room for a fixed period with limited air. Yet there is only enough air for one person to survive that long. Tragically, if both live, they will both die 50% of the way through the fixed period. Yet, one of the men is terminal with cancer anyway, though may live for several months still. The other man, therefore, considers smothering him.

The healthier man could probably argue that the other man's death was not part of his moral object directly, merely the "cessation of breathing." That he doesn't will the man with cancer's death itself, though he'll accept it as a side-effect, merely for the other man to stop using up the oxygen in the room (but if he could do that while somehow remaining still alive, the healthier many would be fine with that). In itself, thus, it might not be "murder" as a moral object in the strict sense of death directly willed as an ends or a means.

Nevertheless, this is still wrong and at least equivalent to murder. Even to save a life, even with someone "already dying" (and we all are!)...human life is of infinite value and death cannot be accepted, even as a side effect, unless the choice is truly "one or both together." Now, in this case, it might seem to be. Both will die if someone does not stop using air first, they are stuck with the same air supply.

But, at the same time, the death of this man with cancer is not bootstrapped to the other man's life in a dependent way. Because either one of them in the room could be smothered with the same effect. Standing in judgment and determining that just because he probably has less time left anyway that therefore his life is less valuable your simply not a judgment we can make given a Christian view of human life. This would remain true even if the were 10 people in the room with only enough air for 9. As far as we know, those few months that cancer patient has left on earth may be more valuable in God's eyes than the collective decades or centuries that the 9 all together would live.

It is only when, as in the case of mother and unborn child, or of a paralyzed climber strapped to his partner, where only one person can survive anyway, and where the other person's death, specifically, would be inevitable due to the very fact of the death of their partner anyway, that such a choice could be made. If, however, the inevitable death of at least "one" or both does not, by nature, specify which one (thus requiring a human choice of one life over the other, as in the air-supply example)...we cannot morally presume to make such a choice.

Nor can we even if (as in the organ donation case) "which one" would die (if both don't) does seem to be specified by the circumstances (in the case of the donation example, it's the donor who would die if both don't), if that death would remain causally independent of the other's death (in the case of the donation, the organ donor is going to die either way, but the inevitability of his death is not dependent on the recipient's death).

This cannot be admitted because, if it were, it would open the door to removing anyone's organs (and accepting death as a "side effect" of that), since we're all inevitably dying (it's merely a matter of degree). So it's not allowable to accept death as a side-effect merely in the case of a choice of "one or both" nor even "a specific one, or both," but only in the case where the choice is between saving one or both dying together (ie, not merely causally independently or coincidentally). Anything else means standing in judgment over the value of human life, however brief, in a way that only God can.

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