“Summarizing an Article by John Finnis on Euthanasia”
Dr. Mark S. Latkovic
February 19, 2014
John Finnis, “Economics, Justice, and the Value of Life,” in Finnis, Human Rights & Common Good, Collected Essays: Vol. III (Oxford University Press, 2011), pp. 242-250.
This article by the moral and legal philosopher John Finnis is brief, but it sure is powerful. It provides not only a devastating critique of euthanasia, but also a window into many of the long-standing ethical concerns of this natural law scholar’s academic work. Originally published in 1992, the essay takes on two influential legal theorists/philosophers who are still influential today: Richard Posner and Ronald Dworkin (d. 2013). The essay is composed of three sections. We will summarize each section in order and then offer some brief concluding thoughts.
F begins by describing Posner’s Economic Analysis of the Law approach (circa 1979), which evaluates legal arrangements according to their economic efficiency (=wealth maximization). Significantly, Posner (now a federal judge) eventually abandoned (in 1990) this model as a sound criterion of moral judgment, given the fact that it is incapable, he concedes, of responding to arguments it cannot really answer.
F notes that although economic thinking can be helpful for various reasons (e.g., it reminds us that our resources are limited and so we have to make choices: either this or that, but not both), it cannot comprehend and explain the two basic forms of justice’s requirements: (1) that we refrain from choices/acts that are incompatible with treating someone well; and (2) that we refrain from causing/accepting unfair consequences/side effects in our choices/actions.
The basic difficulty, in short, with all economic reasoning as a comprehensive criterion of rational choice, F argues, is its attempt to do what is not truly possible: to weigh/measure the greater good/lesser evil (and so on). The basic human goods, being incommensurable, are not capable of being weighed/measured in the way that economics or other aggregative methods (e.g., utilitarianism) require. In fact, as F shows, if one could identify the option that promises the greater good/lesser evil, free choice would not even be possible; for the option identified as the “lesser good” would have no rational attraction. In other words, it would no longer be an option for choice, having simply fallen away.
Of course, F observes, not all measurements/comparisons relevant to human action are impossible. For example, the precise goal of some particular treatment provides a rational measure of efficacy and, in that sense, of benefit. But, he adds, any full assessment of options in the treatment of elderly long-term patients (his primary concern in this essay) will escape the bounds of measurability. This is so because the real question before us is whether the treatment’s benefit (if any) is a benefit which, all things considered, is worth seeking and having. Perhaps, as a utilitarian might ask, this patient’s continued existence, even with minimal care (i.e., providing comfort and sustenance), is of no benefit to anyone?
This question is a live issue in the context of choice between alternative options. F then turns to this context by first, once again, dismissing the proportionalistic calculus of the greater good/lesser evil approach as not simply wrong, but impossible, noting too that this context well illustrates one of the main sources of this (pre-moral) incommensurability of options. What are these options? (1) Continue to give or accept sustenance; (2) Withhold or withdraw it, thinking that the costs of the patient’s continuing life outweigh any benefits; here the proposal is to terminate life, i.e., kill the patient, in order to cut these costs by discontinuing sustenance; and (3) Withhold or withdraw sustenance, on the subtly different ground that giving sustenance is wasteful because the patient’s continuing life yields no net benefit; one’s purpose is to cut costs, but the proposal is not precisely to kill as a means of cutting costs but to abandon the patient to death.
F says his point is this: the benefits and costs involved in alternative options such as these are real and striking, but elude an economic calculus or any other process of aggregating pre-moral goods. Each is an option with enormous implications and ramifications for everyone’s life and existence. Whichever proposal is adopted, it will have an impact on the characters, the attitudes, the relationships, etc. of everyone involved (patients, doctors, nurses, etc.). And all of these effects elude measurement, yet are very real and are really involved, as benefits/harms in the only relevant object of weighing/comparing: the alternative options (of treating/sustaining, of killing, and of abandoning the patient) to be considered in deliberation and accepted or rejected in free choice.
In this section, F maintains that to have an appreciation of the value of human bodily life it is not enough to understand the fallacies of economic approaches which apply technique to non-technical decisions. Indeed, Dworkin himself is a critic of such approaches and even affirms what he calls the “intrinsic value of human life.” However, what Dworkin means by this phrase is radically different than what pro-lifers mean by it. For Dworkin, if life is not going well or not likely to go well, it is not worth living. Thus, e.g., abortion can be morally recommended or required.
Dworkin even rejects the view that the life of the comatose has any value. They are better off dead, he argues. And so caring for them is pointless and degrading.
F points out, however, that a comatose person can be subjected to various indignities (e.g., being treated as a sex object). But F’s real concern here is the dehumanizing rhetoric that is used by Dworkin and the U.S. Supreme Court’s four dissenting judges in the 1990 Cruzan end-of-life case. They confuse, says F, the emotionally repugnant aspects of long-term coma with lack of human dignity in its rational and essential sense. According to F, one who helps the comatose is serving their dignity and expressing solidarity with them as, while gravely disabled, still human persons.
But is such care pointless? If, as Dworkin and the dissenting judges contend, life without cognitive-affective function is of no value, then that bodily life must be an instrumental good, distinct from what human persons are. Thus, this individual is no longer a person, has no personal interests at stake.
But F states that this is an issue to be decided by reason, not feeling and rhetorically stirred imagination. F recognizes of course that nobody wants to live in a comatose condition. The good of human life is very inadequately instantiated in such a life, so deprived and so unhealthy. But this does not show that human life considered in abstraction from all other human goods is of no intrinsic value. No human good, considered apart from all the others, in a mode of existence deprived of all the others, is appealing. But this does not show that basic human goods are instrumental or other than intrinsically good. No more does the unappealing nature of comatose life show it to be valueless. For it is the very actuality of one’s living body, and one’s living body is one’s person.
To deny that one’s living body is one’s person is to accept some sort of dualistic theory of human persons, which sees persons as inherently disembodied realities who only have bodies, only inhabit and use them. But, F argues, no form of dualism is rationally defensible. Every form of it renders inexplicable the unity in complexity which one experiences – the most intimate and thorough unity we experience – in every act one consciously does. The one reality that I am involves at once consciousness and bodily behavior; and dualism sets out to explain me. But it does not do this; rather, F says, quoting Catholic moral theologian Germain Grisez, it tells me about two things, one a nonbodily person and the other a nonpersonal body, neither of which I can recognize as myself.
One’s living body, then, is intrinsic to one’s personal reality. In other words, one does not have or possess a body, one is a body. Thus, human life – the very actuality of one’s body – is a good intrinsic to one. It is not an instrumental good, but, being intrinsic to the original unity of the person, it shares in the dignity of the person.
After noting that the good of human bodily life can be instantiated more or less perfectly, F then argues that even a life burdened and debilitated remains specifically human and inherently good. As he puts it, even human bodily life in a coma has value. His or her killing would harm that person. Despite feelings of compassion to the contrary, such a choice is inconsistent with rational love, justice, and respect for that person.
Finally, F deals with how such a choice differs profoundly from two other sorts of choice or attitude with which euthanasia advocates usually confuse it. (1) He shows how therapeutic surgery (to remove, e.g., a gangrenous limb) is not a case of choosing to do harm (or any other sort of evil) for the sake of good. (2) The choice not to undergo [extraordinary/disproportionate] medical treatment can be a reasonable choice even in cases where it is known that the consequence of the choice will be an early death. The latter is not sought as a means (or an end) but is simply accepted as a side effect.
F’s conclusion is that whatever one’s feelings, it cannot be right to intend death or any other harm to oneself or another. It can be reasonable to act on one’s aversion to the costs and benefits, provided one is not making a choice contrary to any of the rational requirements which we call moral standards (e.g., the norm excluding intent to kill or harm, and the norm requiring fairness to others, but also highly specific standards that one has made relevant to oneself by one’s commitments, vocation, and particular undertakings).
Here in the last section, F offers some brief remarks, more practical in nature, which follow from comments he makes on the papers (which his is but one) that appear in the volume, The Dependent Elderly, Gormally (ed.). These remarks concern what solidarity with the very dependent looks like in practice as well as the very real dangers of what happens when a dualistic attitude to human bodily life reinforces and is reinforced by the belief that we can rationally aggregate the costs and benefits involved in the alternative options: (1) killing out of compassion, and (2) care which excludes both the choice to kill (by act or omission) and the choice to continue treatment which is futile or imposes burdens one has no responsibility in fairness or fortitude to bear. F does recognize, however, that fairness can cut both ways, i.e., some activist elderly groups looking out solely for their own interests, can propose and secure the placing of unjustifiable burdens on younger persons with immediate responsibility for children.
With respect to the allocation/rationing of healthcare resources, F says that some questions will be easy to decide, others will always remain difficult to figure, but some can and should be answered prior to all reasonably disputable issues of allocation, and which we can and should answer in a definitive direction, thereby establishing boundaries for all subsequent allocative choices. At his point, F quotes a lengthy passage by Catholic bioethicist Luke Gormally indicating one of these boundaries.
This boundary, i.e., what is “minimally required” in a well-resourced society, comes across in F’s last paragraph, where, he says, there can be social conditions where no treatment actually available prevents rapid deterioration or succeeds in palliating distress, and where what care and sustenance is available is fairly reserved for the young. But even in such conditions, which are far from the conditions of our society, justice excludes, F reminds us, all choices to kill, and reason undercuts every claim that the life of the dependent elderly is a null or negative value which one may reasonably choose to terminate.
My Concluding Comments
This essay provides a compact and compelling case against euthanasia, and the dualism and economism that often justifies it. It articulates sound arguments, principles, and norms as it responds to those who favor euthanasia in some form. It also discusses the kind of care that is appropriate for those persons, such as the dependent elderly, who are often candidates for euthanasia. As well, when addressing this kind of moral care, F helps us to think properly about the rationing of healthcare resources – surely a timely topic today. In all, it is a worthwhile contribution to the debate over euthanasia by a world-class moral philosopher and scholar.