The Ethics of Euthanasia (Part Four)

(Part One, Part Two, Part Three)

This post is the final part of my brief series looking at the ethics of euthanasia. The series follows the pair of essays from Michael Tooley and Daniel Callahan in the book Contemporary Debates in Applied Ethics . In the most recent post, I looked at the first part of Callahan’s anti-euthanasia argument. In this post, I wrap things up by looking at the rest of what he has to say.

As we saw, Callahan is worried about social consequences of legalising abortion. He thinks proponents of euthanasia mistakenly construe the decision to end one’s life (with assistance) as a private decision, and consequently as something that should be left within the zone of self-determination. This is wrong because euthanasia is necessarily a social act: something that requires the assistance of another individual. What’s more there are reasons to be concerned about the fact that that other individual is likely to be a member of the medical profession. I examined those reasons the last day and found them to be somewhat suspicious.

Today we continue to develop Callahan’s critique by briefly considering three issues. First, the distinction between killing and letting die. Second, the worries arising from the Dutch experience with legalised euthanasia. And third, the personality-type most likely to avail of euthanasia.


1. Killing vs. Letting Die
I won’t talk about this issue too much since I have a podcast planned on the topic. Suffice it to say, there is a tradition within applied ethics that maintains there is an important distinction between actively killing someone and passively letting them die. We talked about this previously when looking at Tooley’s pro-euthanasia essay. The reason this is important when it comes to euthanasia is that some people think it is okay for individuals to refuse life-preserving medical treatment (and thereby let themselves die), but do not think it is okay for the same individuals (with assistance from their doctors or families) to take active steps toward killing themselves.

Euthanasia advocates sometimes try to exploit the openness of people to the passive forms of euthanasia when defending its active forms. They do this by arguing that there is no important moral difference between killing and letting die. James Rachels was perhaps the leading proponent of this argument. Unsurprisingly, Callahan rejects it. He thinks that proponents of the “no difference” argument are confused. They fail to appreciate the nature of a doctor's decision to “let someone die”. Basically, he points out that life is fatal and that, ultimately, doctors can’t prevent death, they can only postpone it. Thus, they aren’t really killing people when they withdraw treatment, they are just making unavoidable decisions about the best use of medical resources.

I find Callahan’s analysis to be a little shallow here. There are complex issues to be addressed in determining what counts as a cause of what, and he fails to discuss those. Also, Tooley’s argument, which opposes Callahan’s, does not rely on this killing-versus-letting-die distinction and so the issue can be sidestepped by the euthanasia advocate. In any event, I think Frances Kamm does a better job of discussing the difference between killing and letting die in some of her work, and I’ll do a podcast on it in the near future. So let’s just move on.


2. The Dutch Experience
As noted last time, one of Callahan’s primary worries about euthanasia is that, if legalised, it will add to the range of permissible killing in society. And if we add to the range of permissible killing, we will find ourselves sliding down a very slippery slope indeed.

He illustrates his point by reference to a study done on the regulation of euthanasia in the Netherlands. Throughout the 1970s and 1980s, Dutch courts allowed for euthanasia provided certain conditions were met. Although the legal situation has changed more recently, it is this period that is covered by study referenced by Callahan. The study, which dates from 1992, was an anonymous survey of the Dutch physicians who were responsible for ensuring that the conditions mentioned by the courts were being met. Despite repeated assurances over the preceding years, the survey found that 50 percent of euthanasia cases went unreported, and that 1/3 were cases of non-voluntary euthanasia.

Callahan finds this shocking and a dramatic illustration of the slippery slope mentioned above. I’m not too sure. Although I’m unfamiliar with the all empirical data on the Dutch experience with euthanasia, I think it’s worth recalling the observation made by Tooley: what matters here is not whether there are undesirable cases of euthanasia in the Netherlands, but whether there are more such cases than when compared to countries that don’t have legalised euthanasia? After all, just because a practice has not been legalised does not mean it is not taking place. Tooley thinks that when the appropriate comparative exercise is carried out, the results lead us away from Callahan’s pessimistic view.


3. Catering for the Autonomous
Callahan closes his essay with an interesting observation. After examining evidence from Oregon (which also has a form legalised euthanasia) he notes that very few people actually avail of euthanasia. In practice, those who suffer from painful, debilitating and terminal illnesses tend to make do with palliative care, no matter how unbearable their lives have become. What's more, those who do avail of euthanasia tend to share an unusual personality trait. They are, for want of a better word, control freaks; people who need to exert decision-making power over all aspects of their lives. Given the concerns he has already expressed, Callahan thinks there is no good reason to legalise euthanasia simply to cater to the needs of such people.

I’m not sure what to make of this suggestion. There is, no doubt, a pejorative undertone to what Callahan is saying. He clearly thinks that control freakery is not to be encouraged (this is a general worry, see here for example). Well, when you put it like that, I guess this sounds right. But, still, I don’t think personal autonomy is something to be sneered at. Indeed, I think it is a key moral value in liberal societies, something that should be cherished. However, let’s suppose that I’m wrong about this and that autonomy is simply neutral, it still would not follow that, just because it is a minority interest, it shouldn’t be accommodated by the law. Minority groups are often given special treatment by the law. So I can’t see exactly what Callahan is getting at here.

The Ethics of Euthanasia (Part Two)

(Part One)

This post is the second in a short series on the ethics of euthanasia. The series follows the pair of essays in the book Contemporary Debates in Applied Ethics. Right now, I am looking at Michael Tooley’s “pro” euthanasia essay. In part one, I outlined, in some detail, Tooley’s basic argument. In this part, I’ll consider Tooley’s second argument, as well as his views on the legalisation of euthanasia.


1. From Passive to Active Euthanasia
To understand Tooley’s second argument we need to bear in mind the different forms of euthanasia. As you recall from part one, particular instances of euthanasia can vary along two dimensions: (i) the voluntary-involuntary dimension; and (ii) the active-passive dimension. The first of these dimensions is concerned with the attitudes of the person being euthanised to their death (did they consent to it or not?), while the second is concerned with the type of assistance offered to that person (does a third party act to bring about their demise or is their demise brought about through omission?).

The most ethically contentious form of euthanasia is the voluntary active one. This form of euthanasia arises whenever a person A performs some action which has as its direct intention the killing of another person B, and B consents to this. Contrariwise, the voluntary passive form of euthanasia is relatively uncontentious. Most people seem to think it would be okay for B, in certain circumstances, to forego life-preserving treatments. The asymmetrical reactions to these forms of euthanasia opens up an intriguing possibility: if we can convince people that there are no morally significant differences between the active and passive forms of voluntary euthanasia, then perhaps we can convince them that euthanasia is morally permissible.

This is exactly what Tooley’s second argument attempts to do. It tries to show that there are no good grounds for thinking that two cases are ethically different. Let’s see how he makes his case.


2. The Difference between Killing and Letting Die
Tooley starts by offering the following argument:

• (1) Voluntary passive euthanasia is not morally wrong in itself.
• (2) Intentionally killing a person and intentionally letting a person die are, in themselves, morally on a par.
• (3) The only intrinsic difference between voluntary active euthanasia and voluntary passive euthanasia is that the former is a case of killing, and the latter a case of letting die.
• (4) Therefore, voluntary active euthanasia is not morally wrong in itself.

Premise (1) is likely to be accepted by most people, and premise (3) is just an implication of the definitions of active and passive euthanasia. This means that premise (2) is where the controversy might be thought to lie.

Is it really true to say that intentional killing and intentional “letting die” are morally equivalent?

Some philosophers are likely to argue that there are important moral differences between the two cases. In making their argument, they might appeal to the famous thought experiments involving organ donation. For instance, consider the following. You are doctor in a hospital with two patients, both of whom need organ transplants to survive (say one needs a kidney and the other needs a heart). As luck would have it, a healthy person who is a perfect match for both patients walks into your hospital ward. If you kill the healthy person and harvest their organs, you can save your two patients. Should you do it? Most people say “no” but this is puzzling if there’s no moral difference between killing and letting die. After all, if there were no moral difference then surely letting two patients die would be worse than directly killing another?

Tooley thinks we can skirt these difficulties by first acknowledging the following asymmetry principle which, presumably, motivates the objection to premise (2):

(A) The property of killing a person and the property of allowing a person to die are, other things being equal, wrong-making properties of actions, but the former is a weightier wrong-making property than the latter.

See what we’ve done here? We’ve acknowledged that killing and letting die are morally undesirable, but we’ve also accepted that the former is worse than the latter. This can account for our reaction to the organ donation case.

But this asymmetry principle is problematic in the present context. As David Boonin argues, if principle (A) is true, then the following more general principle ought to be true:

(B) Both the property of intentionally causing a harm, and the property of intentionally allowing a harm to occur are wrong-making properties of actions, but the former is a weightier wrong-making property than the latter.

Principle (A) would actually be derivable from (B) since (B) expresses the more general rule that harming is morally bad. The problem this creates is the following: in the euthanasia case the claim is that killing a person is not actually a harm to them but is, in fact, a benefit. This is why I included the clause “other things being equal” in my formulation of principle (A): the point being that in euthanasia cases “other things” (namely, the relationship between death and harm) are not equal.

We can go further with this line of thought by noting that (B) would seem to have an obvious corrollary:

(C) Both the property of intentionally causing a benefit and the property of intentionally allowing a benefit to occur are right-making properties of actions, but the former is a weightier right-making property than the latter (or, at a minimum, is at least as weighty a right-making property as the latter).

From which could be derived the following revised version of premise (2):

• (2*) Both the property of killing a person, when the killing benefits the person, and the property of allowing the person to die, when allowing the person to die benefits the person, are right-making properties of actions, and the former is at least as weighty a right-making property as the latter.

When plugged back into the argument given above, (2*) allows us to reach the same conclusion. But is it any less objectionable than the original version?



3. The Revised Form of Premise 2
Tooley thinks there is one plausible line of objection to the revised version of premise (2). This line of objection holds that the property of killing a person, even when the killing benefits them, cannot be a right-making property of an action since the direct killing of an (innocent) person is always morally wrong in and of itself. The “innocent”-caveat here is a concession to those who think that under certain conditions it is morally good to inflict capital punishment on a guilty person.

To those who mount this objection to (2*) we must ask: what basis is there for thinking that killing innocent persons is morally wrong in and of itself? There are two possibilities here (according to Tooley). Appealing to axiology, we could argue that the existence of innocent persons always makes the world a better place than it would be if they failed to exist (2.1). Or, appealing to the notion of rights, we could argue that all innocent persons have a right to life and so any violation of that right would be morally wrong (2.2).

The appeal to axiology faces two objections. First, if it is true, then intentionally refraining from bringing persons into existence is also morally wrong in the exact same degree. This is implausible (2.3). Second, looking at cases of people suffering considerable pain due to incurable illness, the proponent of the axiological appeal must believe that their continued existence is a net benefit to the world. But then should they not also hold that the failure to bring into existence a person who will live a life of considerable pain is morally bad? Again, this seems very implausible (2.4).

The appeal to rights is also problematic. For starters, people can, in general, waive their rights (2.5). What’s more, the claim that the death of those who are suffering considerable pain due to incurable illness violates their rights is likely to be false. Why is this? Well, consider that there are two plausible theoretical bases for rights, either (a) rights protect individual interests or (b) rights protect freedom of choice. But in the voluntary euthanasia case, the claim is that death is either (i) in the person’s interests or (ii) something they desire for themselves. Therefore, on neither account is voluntary euthanasia a violation of individual rights (2.6).

That gives us the following completed argument map.

4. The Legalisation Debate
Through his two arguments, Tooley feels he has made the case for the moral permissibility of voluntary active euthanasia. But just because something is morally permissible does not entail that it should be legalised. For example, some people think that, under extreme circumstances, interrogative torture is morally permissible. But the same people do not necessarily think that the legal ban on torture should therefore be relaxed. Laws alter people’s incentives and these alterations may not be morally desirable. So before pronouncing on legal policy, Tooley considers three objections to the legalisation of voluntary active euthanasia.

The first objection comes from Yale Kamisar. He argues that if voluntary euthanasia is legalised, some people will consent to being killed in cases in which their death is actually contrary to their own interests. Tooley is pretty quick in his dismissal of this argument. He argues that, unless the person is emotionally or psychologically disordered, there no reason to think they will fail to appreciate good reasons for their continued existence if such reasons exist. Also, he argues that this objection fails to distinguish between the active and passive forms of voluntary euthanasia. So if it’s a good objection to legalising the active form, then it’s also a good objection to legalising the passive form. That’s a problem for Kamisar since, according to Tooley, he accepts the latter. So much the worse for Kamisar, I guess.

The second objection appeals to the notion of a slippery slope: if we legalise voluntary active euthanasia, what’s to stop us from legalising other undesirable things such as involuntary euthanasia? Kamisar also makes this argument. He justifies this by pointing out that advocates of voluntary active euthanasia often think that certain forms of non-voluntary euthanasia should be legalised. He also points to the historical experiences in Nazi Germany and suggests that some of the problems there were attributable to an initial acceptance of the proposition that there is such a thing as a life not worth living. And from there it was but a short slide down the slippery slope to racial extermination.

There are many things that could be said in response to this. We can start by pointing out that there is a distinction between non-voluntary and involuntary euthanasia and that acceptance of the former would not logically entail acceptance of the latter. Turning to the Nazi case, we become embroiled in a dispute over historical causality. The claim that there was a slippery slope from the acceptance of one proposition about the worth of life to policies of racial extermination is certainly debatable. Some would argue that the ideology of racial purity and supremacy predated the acceptance of the claim that some lives are not worth living. And that this is a more likely cause of the extermination policies. Whatever the case may be, it seems that the Nazi experience is likely to have multiple, historically contingent causes, most of which will not apply to modern societies.

Furthermore, in response to the slippery slope argument, we can point to empirical evidence suggesting that the slippery slope will not arise. The best set of evidence comes, of course, from the Netherlands which has legalised voluntary active euthanasia. The evidence from the Netherlands is controversial. Some (including Callahan, who we’ll talk about the next time) argue that the Dutch experience actually does provide evidence of a slippery slope because there have been cases of involuntary euthanasia there. Tooley disputes this, however, because it fails to contrast the situation in the Netherlands with the situation in countries which have not legalised voluntary euthanasia. He argues that when you contrast it with such a country (he uses the example of Australia) you find that there are more cases of involuntary euthanasia in the other countries.

I’m a little bit wary of this empirical evidence because Tooley only compares figures over the years 1995-1996 (and he’s basing this on analyses done by others). I haven’t read this evidence and I haven't read any countervailing evidence either. Nevertheless, there is an interesting point here: regulation of an activity can sometimes lead to fewer rights-violations than non-regulation because people are suddenly made accountable for decisions which were previously carried out under the radar of the law.

The third and final objection to legalisation is this: there is uncertainty about the form that legal regulation should take. Should there be complex and stringent guidelines for those who carry out voluntary euthanasia? Or should there just be some general principles? If we opt for the former, then some people who might benefit from euthanasia might be excluded. And if we opt for the latter, rights might fail to be protected.

Tooley’s proposal is this: First, we follow James Rachel’s suggestion and make voluntary active euthanasia a defence to a charge of murder or manslaughter (like self-defence). And second, we combine this with rather conservative and stringent regulation. The former would allow for a certain degree of flexibility, while the latter would protect against abuses.

I have no idea whether this dual regime would work. My preference would be for complex and stringent guidelines since, acknowledging that errors will be made, I think we should err on the side of preserving life rather than ending it.

This brings us to the end of Tooley's essay. In the next part, we'll look at the anti-euthanasia essay by Daniel Callahan.

The Ethics of Euthanasia (Part One)

The book Contemporary Debates in Applied Ethics recently found its way into my hands. It's a decent collection of essays on topics ranging from abortion, to capital punishment, to world hunger. As might be expected from a debate book, it adopts a “pro” and “anti” format. In other words, there are eleven pairs of essays with each pair consisting of an essay defending a proposition and another one opposing the same proposition. Unfortunately, the interplay between the essays isn’t perfect and, as per usual, the authors occasionally talk past one another. Still, the standard of discussion is high and it makes for rewarding reading.

Anyway, I thought I might share some of the book here on the blog since the argumentative back-and-forth of the essays fits well with the kind of analysis I usually undertake. First up will be the pair of essays on euthanasia. The pro essay is written by Michael Tooley; the anti essay is written by Daniel Callahan. I’ll go over Tooley’s essay first (it might take a few posts), then I’ll turn to Callahan’s essay.

In this post, we’ll go through some conceptual distinctions and we’ll look at Tooley’s basic pro-euthanasia argument. I should clarify at the outset that Tooley isn’t necessarily “pro” euthanasia. He just thinks it isn’t morally wrong. In this respect, his argument might be thought to resemble the pro-choice position on abortion.

1. The Euthanasia Landscape
Tooley adopts the following definition of euthanasia:

“Euthanasia” = Any action where a person is intentionally killed or allowed to die because it is believed that the individual would be better off dead than alive — or else, as when one is in an irreversible coma, at least no one is worse off.

So understood, “euthanasia” captures a rather broad range of activities. Certainly much broader than the range of activities that Tooley’s opponent Callahan thinks fall within the rubric of “euthanasia”. Callahan defines euthanasia as the direct killing of a patient by a doctor. Such a definition is, as Tooley notes, narrower than his in at least three ways. First, it excludes killing by means of omission ( e.g. withdrawing life support). Second, it excludes methods of killing that are indirect (Tooley cites the example of a morphine dose which leads to respiratory failure but which is directly intended to reduce pain). And third, it limits itself to patients. Tooley thinks these limits are morally irrelevant. More on this in a later post.

For now, we need to be a little bit more discriminating in our conceptualisation of euthanasia. In particular, we need to pay attention to two dimensions along which particular instances of euthanasia can vary.

The first of those dimensions captures the distinction between voluntary, non-voluntary and involuntary forms of euthanasia. An instance of euthanasia is voluntary if the person who is euthanised either consents to or requests their death. An instance of euthanasia is non-voluntary if the person who is euthanised does not have the capacity to communicate their desires (e.g. as in a coma). And finally, an instance of euthanasia is involuntary if the person is euthanised against their will.

The second dimension captures the distinction between passive and active forms of euthanasia. There are different ways of understanding this distinction. According to one, the distinction is between killing someone by omission ( i.e. by doing nothing) or by performing some act. Alternatively, the distinction is between the primary causes of death. If the primary cause of death is human action, then we have a case of active euthanasia. And if the primary cause of death is disease or injury, then we have a case of passive euthanasia.

With those dimensions in place, we can construct the following grid.

The grid captures all the possible forms of euthanasia. We can assign moral statuses to each of these forms. I note that most people think that passive voluntary euthanasia is morally permissible, i.e. they think its okay for someone to refuse to undergo life-saving treatment (in certain cases). I also note that many people think that passive non-voluntary euthanasia is morally permissible, i.e. a family can withdraw life-support from a relative who is in a persistent vegetative state. What we’re interested in here is whether active voluntary euthanasia is morally permissible.


2. Making The Case for Active Voluntary Euthanasia
If you have any familiarity with Tooley’s writings you’ll know that he has a penchant for long formal arguments (check out his SEP entry on the problem of evil for a good example of this). It should come as no surprise then to learn that his basic argument for active voluntary euthanasia is quite long. One of the nice features of this approach is that it tends to make for a logically strong argument. Tooley tends to build his case in a series a fairly uncontroversial stages, and these stages tend not to rely on implicit premises — as is often the case in arguments of this sort. That’s not to say there’s no controversy to be had — of course there is — but at least he tries to build a comprehensive case.

In the euthanasia essay, Tooley presents his argument initially as one whole unit and then works through the justification of the various stages. I’m going to reverse that order of presentation here: I’m going to go through the various stages first and then I’m going to present the whole argument, with an argument map, at the end. Here we go.


3. Stage One: Suicide can sometimes be in a person’s interest
The first stage of argument proposes that a person’s committing suicide is — under certain circumstances — in that person’s interest. It looks like this:

• (1) If a person is suffering considerable pain due to an incurable illness, then in some cases that person’s death is in his or her own interest.

• (2) If a person’s death is in his or her own interest, then committing suicide is also in that person’s own interest.

• (3) Therefore, if a person is suffering considerable pain due to an incurable illness, then committing suicide is in that person’s own interest.

This argument is logically valid (“If A then B” + “If B then C” → “If A then C”). It is also relatively innocuous: It says nothing, yet, about whether suicide is morally permissible. It only says that it can be in a person’s interest. Still, some people might object to its premises and we must see what can be said in their favour.

As regards premise (1), Tooley makes two supporting observations. First, he notes that many people who suffer from painful and incurable diseases come to welcome their own deaths. Since people are generally assumed to be good judges of what is in their interest, this implies that their deaths are (likely) in their own interests. Second, he notes that the family members of those who suffer from such diseases also welcome their deaths. We will add these two supporting observations into the completed argument map as (1.1) and (1.2) respectively.

As regards premise (2), Tooley notes that some religious believers are likely to reject this premise. For instance, Catholics who believe that suicide is a sin, and that anyone who commits it is destined for Hell, are likely to reject it. We’ll give this objection the number (2.1) There are a couple of ways to respond to this. One would involve a major detour into the philosophy of religion and might end up arguing that a good God is unlikely to send people to Hell for eternity. An alternative response — the one Tooley endorses in the interests of time — is to point out that Catholics think that many things (homosexual acts, premarital sex, contraception and masturbation) are sins. So anyone persuaded by Catholic doctrine on suicide must adopt a similar attitude towards these acts. The suggestion is that most people are unlikely to do this and so this objection to premise (2) fails. These points will be added to the argument map as (2.2) and (2.3).


4. Stage Two: Suicide is not (always) morally wrong
We now move on to the next stage of the argument. This stage focuses on the transition from “in a person’s interest” to “not morally wrong”. As follows (note: (3) serves as the first premise of this argument, but I’m not going to write it out again):

• (4) A person’s committing suicide in such circumstances may very well also satisfy the following two conditions: (a) it neither violates anyone else’s rights, nor wrongs anyone; and (b) it does not make the world a better place.

• (5) An action that satisfies conditions (a) and (b), and that (c) is not contrary to one’s own interest, cannot be morally wrong.

• (6) Therefore, a person’s committing suicide when that act does not violate conditions (a), (b) and (c) is not morally wrong.

There are a couple of things going on here. On the one hand, premise (5) is setting down certain conditions for moral rightness. On the other hand, premises (4) and (3) are saying that those conditions are met in certain cases of suicide. Let’s look at the conditions first and then consider whether they actually are met in certain cases of suicide.

Conditions (a) and (c) appeal to the idea that to be morally wrong an act must wrong some sentient being by violating their rights or undermining their interests (on certain conceptions of rights these are one and the same thing). By themselves these conditions would seem uncontroversial. The major objection to them is that they do not exhaust the conditions of moral wrongness. Derek Parfit, for instance, has a famous thought experiment in which you are asked to choose between two actions. The first of which will lead to future generations enjoying an extremely high quality of life, and the second of which will lead to future generations having lives that are not worth living.

The typical reaction to this thought experiment is that to perform the second action would be to do something morally wrong. But this reaction is difficult to explain if (a) and (c) exhaust the conditions of moral wrongness. After all, the future generations who are harmed by the second action are not yet alive and so cannot be wronged by your actions in the present. This suggests that there is more to wrongness than just harming the rights and interests of sentient beings (other thought experiments can be used to reach similar conclusions). And this possibility is exactly what condition (b) is designed to cover.

So the conditions of moral wrongness seem to be sound, now we must ask whether they will be met in certain cases of suicide. We have already seen in stage one how condition (c) can be met when the person is enduring considerable pain due to an incurable illness. So we focus here on (a) and (b).

Tooley argues that in the same circumstances condition (a) can be met. How so? Well, although it is true that those contemplating suicide in such cases will have obligations to others, they are unlikely to be able to meet those obligations due to the pain they are suffering (4.1). Furthermore, obligations usually allow for some level of cost-benefit analysis to determine whether they need to be fulfilled — if the personal cost of fulfilling the obligation is exceptionally high, as it might be in cases of incurable illness, then the obligations may be relaxed (4.2).

There is an obvious objection to this. Some might argue — contra the above — that ending one’s own life violates God’s right of ownership over us (4.3). Tooley detects three flaws with this response. First, it assumes that God exists when this is unlikely to be the case (4.4). Second, and more importantly, even if there is a God such a right of ownership is highly implausible since it conflicts with moral autonomy, which is generally thought to be a great good (4.5). Third, even if there is some right of ownership over non-autonomous beings — as there might be in the case of pets and their owners — this does not give the owner the right to compel the being to suffer needlessly (4.6). Tooley’s approach here is a bit too kitchen-sinky for my taste. I tend to think that in ethical debates of this sort one should either grant the most complex premises (like the existence of God) for the sake of argument, or else one should engage with them more fully. I don’t like the “this is unlikely” approach taken in (4.4).

Anyway, turning to condition (b), Tooley again thinks it highly likely that this condition will be met in the case of incurable illness with considerable pain. He does so on the grounds that death in these cases (i) ends the suffering to the individual, (ii) is likely to ease the emotional suffering of the friends and families of the individual, and (iii) is unlikely to generate any outweighing suffering due to loss of a loved one (4.7).

In sum, stage two of the argument seems well-supported.


5. Stage Three: Assisting Suicide is not morally wrong
Stage three of the argument makes the all-important leap from cases in which the individual takes their own life (suicide) to cases in which another person assists the individual in the taking of their own life. It says (again, (6) is an unwritten premise here):

• (7) It would be morally wrong for a person (call them “A”) to assist another in committing suicide (call them “B”) if and only if: (i) it was morally wrong for B to commit suicide; or (ii) committing suicide was contrary to A’s own interests; or (iii) A’s assisting B to commit suicide violated an obligation that A owed to a third party C.

• (8) Circumstances may well be such that A’s assisting B to commit suicide was neither (i) morally wrong for B; or (ii) contrary to A’s interests; or (iii) in violation of A’s obligations to any third party C.

• (9) Therefore, it may not be morally wrong to assist another in committing suicide.

This stage of the argument follows a similar pattern to the previous one. It sets some conditions for morally wrongful assistance and then it says those conditions are met in certain cases of assisted suicide.

Let’s look to the conditions of morally wrongful assistance first. Here, I must admit, I’ve hit upon a snag. Although conditions (i) and (iii) seem relatively straightforward, condition (ii) seems less so. The problem has to do with the ambiguity of Tooley’s original formulation of premise (7). Whereas I try to make it clear who is being referred to by introducing the characters A and B, Tooley does not and refers simply to “the person”. Unfortunately, this makes it unclear whose interests are being referred to in condition (ii). I’ve interpreted it above as referring A’s interests ( i.e. the interests of the assister) and I think this makes sense: it would seem imprudent (and likely a condition of wrongness) for A to assist another in undermining his interests. That said, it could be that Tooley is referring to B’s interests and drawing a distinction between objective and subject interests. In other words, the idea is that while B might subjectively think that a particular action (in this case suicide) is in their interests, they might be wrong about this when their interests are assessed from the third-person perspective. So if you, as an outside observer, think that the action is not in B’s interests, you should not assist them in performing it. Again, this seems plausible, but it also expresses a thought more complex than Tooley’s original formulation allowed for.

However the ambiguity gets sorted out, it seems like premise (8) will hold. We have already seen how suicide is not necessarily morally wrong for the person committing it, hence condition (i) can be avoided. Furthermore, there would seem to be circumstances in which either interpretation of (ii) fails to hold. Tooley acknowledges that some people may be members of organisations (religious or professional) which impose an obligation on them not to assist in the suicide of another (8.1). For those people, condition (iii) will be met. But Tooley responds by noting that this obligation will not, in general, be present and so, once again, there are circumstances in which (iii) will not be met (8.2).


6. Stage Four: From Assisted Suicide to Voluntary Active Euthanasia
The last stage of the argument is the easiest. It simply suggests that if assisted suicide is morally permissible, then so too is voluntary active euthanasia. The only difference between the two is that, in the former, the individual plays an active role in bringing about their own demise, whereas, in the latter, a third party does all the work. Tooley contends that this difference cannot be morally significant. So we get:

• (10) Wherever assisting a person in committing suicide is permissible, voluntary active euthanasia is also justified, provided the latter does not violate any obligation that one has to anyone else.

• (11) Therefore, voluntary active euthanasia can, in certain circumstances, be morally permissible.

The completed argument map is below.

Okay, that’s all for this post. In the next part, we’ll consider the distinction between passive and active voluntary euthanasia, and we’ll also look at the legalisation of euthanasia.