More Autonomy

In Melbourne Australia Harry Kakavas lost $20.5 million to a casino. He sued the casino arguing it should have known he was a pathological gambler and as a result not taken his money. He lost his case in the Australian High Court. The Court ruled that Kakavas did not show that he suffered from a disability, special to him, which was exploited by the casino. What sort of disability is relevant in such a case? It would seem in this particular case that Kakavas did not have the ability to make meaningful decisions, decisions which were in his own interests, whilst gambling. Gambling affected his autonomy. The Kakavas case raises questions about the nature and extent of autonomous decisions. In this posting I will examine both of these questions. I addition I will consider when we have a duty to intervene when someone makes a non-autonomous decision; provided of course we have the power to do so as the casino involved with Kakavas did,

Which of the decisions we make are autonomous? It might be thought that these decisions must be important decisions which we make only after careful consideration. A patient giving informed consent might be seen a paradigmatic example of such an autonomous decision. If this is so someone making a decision without appropriate reflection might be said to be making a non-autonomous decision. It might then be argued we can safely ignore her decision because it does not represent her ‘real self’, see Berlin (1). It is not a decision she would have made if he had more adequately reflected on it. I would suggest such an attitude is one of moral arrogance.

I now want to argue almost all of the decisions we make are autonomous. A common theme throughout all my postings is that someone’s autonomy depends on what she ‘cares about’. Caring about in this context means not merely wanting something; it means someone’s identity, her ‘real self’, is dependent on what she cares about. Moreover I have argued in previous postings what someone ‘cares about’ is defined by what she is satisfied with. Satisfaction in this context simply means no resistance to a decision, no restlessness with that decision (2). There is no desire to change the decision. It is important here to be clear satisfaction with a decision does not equate with being happy about a decision. As I have argued before someone with a terminal illness may decide to commit suicide and be completely satisfied with her decision but nonetheless her satisfaction does not imply she is happy about it. Accepting the above means if someone is satisfied with some decision and has no inclination to change her decision that her decision is an autonomous one. I would suggest that people are satisfied, as defined above, with almost all of their decisions. The above leads to the tentative conclusion that almost all of the decisions we make are autonomous.

At this point an objector might be prepared to accept that for a decision to be autonomous it must be based on what we care about. However she might be unwilling to concede that it naturally follows that almost all of our decisions are autonomous. My objector might argue we can only know what we care about after adequate reflection. She might then further argue that because most of our decisions are non-reflective that most of our decisions are non-autonomous. If my objector’s argument is to carry any weight then she must accept one of two options. Firstly someone may make an autonomous decision based on what she cares about and be dissatisfied with her decision. Or secondly she must accept that being satisfied with a decision is a necessary condition for that decision to be an autonomous decision based on what the agent cares about but argue it is not a sufficient condition. Let us examine the first option. An agent can make an autonomous decision and be dissatisfied with it. I accept an agent can make an autonomous decision she’s not happy with, see above, but I can’t accept she can make an autonomous decision she’s not satisfied with. Let us accept satisfaction with a decision does not simply mean the agent has some smug feeling but means she has no resistance to her decision, no restlessness to change it. It follows if an agent is dissatisfied with a decision that she either resists the decision or seeks to change it. She is ambivalent about her decision. I don’t accept that any decision someone is ambivalent about and seeks to change can be an autonomous decision. It follows an agent cannot make an autonomous decision she is dissatisfied with.

Let us consider my objectors second option that being satisfied with a decision is a necessary condition for that decision to be an autonomous one based on what the agent cares about but that it is not a sufficient one. My objector might suggest that for a decision to be an autonomous one not only must the agent be satisfied with it but that she must have reflected on it. This suggestion would mean most decisions we make are non-autonomous. Of course for many of the decisions we make this doesn’t matter. No one is really concerned whether someone’s decision to have an ice cream is an autonomous one or not. However let us consider a family on a summer’s day sitting on the bank of a fast flowing river eating ice cream. Let us assume one of the children falls into the river and without any thought the mother jumps in and saves the child. Was this a non-autonomous decision? I would argue it was an autonomous decision. Indeed the mother might feel hurt if someone suggested afterwards her actions were mindless. She might say she minded very much, she loved her child, and that she couldn’t act any other way, reflection was pointless. The above suggests for a decision to be autonomous all that matters is that the agent cares about it. It suggests that caring about a decision is both a necessary and a sufficient condition for that decision to be autonomous in conditions in which the agent has been neither coerced nor deceived. Of course sometimes an agent may have to reflect on what he cares about but it is caring about rather than reflection that guarantees a decision is autonomous. Indeed it might be argued the fact that an agent feels a need to reflect on a decision make the autonomy of the decision less certain.

My objector might accept that for a decision to be an autonomous one the agent must care about her decision but suggest we don’t really care about many of our decisions. For instance she might point out my decision to buy an ice cream on a sudden whim is not based on what I really care about in the way we have been using the term. We only care about important decisions and only these decisions can be autonomous or non autonomous, mere whims don’t count. I believe this might be the position Frankfurt would adopt, see (3). I however would adopt a slightly different position. I would suggest an autonomous decision need not be one an agent cares about but any decision he makes which is not discordant with what he cares about. If my suggestion is accepted then most of the decisions we make, including my whim to buy ice cream, would be autonomous. At this point my objector might point out my suggestion seems to weaken the connection between autonomy and personal identity. Frankfurt argues our identity is linked to what we care about.

“Caring is important to us for its own sake, insofar as it is the indispensably activity through which provide continuity and coherence to our volitional lives. Regardless of whether its objects are appropriate, our caring about things possesses for us an inherent value by virtue of its essential role in making us the distinctive kind of creatures that we are.” (4).

I agree our identity is connected to what we care about. It might appear that because identity and autonomy are connected that autonomous decisions must be decisions we care about. I believe appearance is unjustified. I have suggested above that autonomous decisions are connected to what we care about, our identity, by being decisions which are not discordant with what we care about, our identity. Of course when making most decisions we don’t reflect about our identity. Nonetheless I would suggest our identity is always present even if only in the background. I would further suggest this presence gives continuity and coherence to our lives. If autonomous decisions are any decisions which are not discordant with what we care about then not all autonomous decisions play an equal part in defining our identity. Indeed some like my decision to have an ice cream may play no part. Nonetheless if I continually buy ice cream I may be said to be someone who likes ice cream and this plays a small part of my identity. In the light of the above it appears an agent caring about her decision is not necessary for her decision to be an autonomous one. Moreover someone’s being satisfied with her decision is both a necessary and sufficient condition for the decision to be an autonomous one in circumstances in which she has not been deceived or coerced.

I have argued that most of the decisions we make are autonomous decisions. In addition I believe we should always accept an autonomous decision even if this decision harms the decision maker provided of course the decision does not harm others. I believe we must give precedence to respecting autonomy over acting beneficently. It seems to me someone’s identity is tied to her autonomy, tied to what she finds appropriate, what satisfies her. If we fail to respect someone’s autonomy we fail to respect her. Let us consider an example. Personally I detest is smoking. Moreover smoking harms smokers. Let us assume I one of my friends is a smoker who on hearing I am going to a shop asks me to buy her some cigarettes. As I am going to the shop anyway I will not be inconvenienced if I buy her cigarettes. Let us also assume she is completely satisfied with her decision, she will not smoke in my presence or that of other non-smoker and that she fully understands the dangers of smoking and is not deceiving herself. Let us further assume I refuse to buy her cigarettes because I believe these will harm her. I am helping her to prevent harming herself by not respecting her autonomous request even though satisfying her request would not inconvenience me. I am giving priority to acting beneficently over respecting her autonomy. I would suggest in this example I am merely paying lip service to respecting her as a person. Perhaps I might console myself that I am respecting her real self, but this real self is really an ideal self created by me. In this example I believe I could justly be accused of some sort of arrogance.

If we accept we should respect autonomy over acting beneficently and most decisions we make are autonomous in the sense used above then we have to accept a large number of decisions which are unwise or even foolhardy. Kakavas’ decision to gamble in the casino was certainly an unwise one but was it also a non-autonomous one? If it was an autonomous one then the casino should respect his decision however unwise it was. In theory it seems there might be completely satisfied gamblers. However in practice most gamblers feel guilty about their gambling and have some resistance to their compulsion to gamble. It follows most gamblers’ decisions to gamble are non-autonomous decisions. It seems probable that Kakavas’ decision to gamble was a non-autonomous one. It follows the casino could not justify, allowing Kakavas to continue gambling, on respect for his autonomy.

In normal life we generally accept peoples’ decisions, even if many of these are not autonomous decisions, provided we have no reason to suspect that these decisions will harm the decision maker. Kakavas’ gambling clearly harmed him. How could a casino possibly justify allowing Kakavas to gamble if his gambling was both non-autonomous and harmed him? One possible justification concerns the nature of the harm involved. Kakavas’ gambling harmed him financially but it might have done only limited harm to his capacity to make autonomous decisions. Kakavas’ capacity to make autonomous decisions was impaired whilst gambling but perhaps it remained unimpaired at other times. He could have made an autonomous decision not to go to the casino in much the same way a recovering alcoholic makes a decision not to go to a bar. The casino might argue even if Kakavas was harmed it was respecting his autonomous decision to go gambling and it was justified in respecting this decision because respecting autonomy should take precedence over acting beneficently. I would accept the above argument. However I would be some what sceptical about a gamblers ability to make a decision she knows will make her feel guilty without any resistance to her decision.

Unintentional Fathers

Should unwilling fathers be forced to maintain their children? The answer is no according to Laurie Shrage. She bases her argument on the facts that an unwilling father has not consented to have a child and does not have the power to have the foetus aborted or the child given up for abortion. In what follows I will make a distinction between unwilling and unintentional fathers. I will argue that whilst most unintentional should be forced to maintain their children some should not.

To start with I want differentiate between two classes of unwilling fathers. There are unwilling fathers who intended to have a child and those who did not. An example of the former would be someone who intentionally fathers a child simply because he loves his partner even though he would rather not be a father. Initially such a father might well support his child simply because he loves his partner. However if his love fades so may his support. It would appear that any unwilling father who intentionally fathers a child, and has made an autonomous choice to do so, can be held responsible for his actions and should help maintain his child. It is possible that a very small subset of the class of intentional fathers may not have made an autonomous decision to become a father. I will not consider these fathers in this posting. In the rest of this posting I will only be concerned with unwilling fathers who father a child unintentionally.

Let us consider a driver speeding recklessly. Let us assume this driver mounts the pavement and harms a pedestrian due to his reckless speeding. The driver did not intend to harm the pedestrian but nonetheless he would be held responsible for his actions and hence liable to pay damages. Now let us consider a man who does not intend becoming a father but nonetheless engages in unprotected sex. Let us assume as a result he becomes a father. It might then be argued by analogy he ought to be liable to pay some maintenance towards his child. It might at this point be objected that my analogy is an inaccurate one. My objector might point out that in the case of the unintentional father the mother has the freedom to abort or have the child adopted, a freedom the father does not have. This point is made by Shrage. Let us revise the case of our speeding driver. Let us now assume that when he mounted the pavement a bystander could have pushed the victim out of the way. Let us assume he did not. It seems to me that in this revised case the reckless driver should still be held responsible for his actions and hence liable to pay damages. Moreover it seems this revised case of the reckless driver is much more analogous to that of an unintended father. Prima facie it might be concluded that all unintentional father should be required to help maintain their children.

It has been suggested to me by Owen Schaefer that the above analogy may fail because simply causing a child to exist does not harm that child. In response I would adopt a position similar to that of Lindsey Porter (1). Porter points out that a biological parent is someone who causes a new person to exist. She then points out children are vulnerable. She proceeds to argue that because a biological parent is responsible for a child’s vulnerability he/she should take steps to remedy this situation. Now of course causing someone to be vulnerable is not exactly the same as directly harming her unless one accepts omissions can have the same moral import as actions. Nonetheless making vulnerable and harming are closely related. Consider a parent who fails to ensure his/her child receives her measles MMR jab. Such a parent makes his/her child vulnerable to catching measles. I will assume such a jab is completely safe and that parents should be aware of this fact. I would suggest in this situation such a parent fails in his/her parental obligation. If my suggestion is accepted then does such a parent fail in this obligation because he/she makes the child vulnerable to measles or does he/she only fail in this obligation if the child actually catches measles and is harmed as a result? I would be reluctant to accept the latter conclusion. If my reluctance is justified in this case then making a child vulnerable is morally equivalent to harming that child. It follows if making a child vulnerable is analogous to creating a vulnerable child that creating a vulnerable child and taking no steps to remedy this vulnerability is morally equivalent to harming that child and this supports my prima facie conclusion above.

I have argued that causing a vulnerable child to exist places a prima facie duty on a parent to support that child. This duty is only a prima facie one and some parents such as a 14 year old mother might well be exempt. However as Schaefer points out accepting this appears to imply gamete donors and fertility doctors would be subject to the same duty. Such an implication is counter intuitive. I have previously argued this implication is unsound and will repeat the argument here.  Let us consider two sisters Ann and Carol. Ann is married but is incapable of carrying a child because she has had a hysterectomy followed by chemotherapy due to cancer. Prior to her treatment some of Ann’s eggs were saved. Carol has two children of her own but nonetheless offers to act as a surrogate mother for Ann. Carol successfully undergoes IVF using her sister’s eggs together with Ann’s partner’s sperm and produces a child. Let us assume Carol will never undertake surrogacy again or have any other children. Clearly Carol played a necessary part in causing Ann’s child to exist. Does it follow that in this situation Carol has any obligation with Ann to assume parental duties? I argued it does not. Ann wanted a child. Having a child of her own was of intrinsic value to her. Carol only acted instrumentally to serve Ann’s wants.  Carol may have played a necessary part in the creation of the child but she would not have done so without Ann’s need. Ann and Carol caused the child to exist in different ways. Ann’s need was the original cause of the child. Carol served this original cause instrumentally. I would suggest only those people who cause a child to exist, by being the original cause of that child, have a prima facie duty to support that child. I further suggest unintentional fathers are among these people. It might appear that people who cause a child to exist by acting instrumentally to fulfil someone else’s need for a child do not have such a duty. It follows that gamete donors, IVF specialists and surrogate mothers do not have a prima facie duty to support any children they help to come into existence.

However the above appearance is too simplistic. It is not always true that someone acting purely instrumentally to serve someone else’s ends has no duties connected to these ends. If this were not so a Nazi who participated in the Holocaust and was following orders should not have been held responsible for his actions. I would suggest anyone acting instrumentally to serve someone else’s ends has a duty to satisfy himself those ends cause no harm. If he is able to satisfy himself his actions to serve the ends of another will cause no harm then he has no further duties connected to these ends. This duty of course applies to IVF specialists and surrogate mothers who have a duty to satisfy themselves that any children born with their help will be well cared for. An IVF specialist who helped a 16 year old become a single parent might not be satisfying this duty; Carol in the above example would. It also seems to follow from the above that any unwilling father who intentionally fathers a child because he loves his partner and believes his partner can support the child on her own does not have a duty maintain his child.

I will now argue not all unintentional fathers have a duty to support their children. I will argue that if an unintentional father is deceived then he does not have a duty to help maintain his child. Let us return to our speeding driver. This driver does not intend to cause harm but he is aware, or should be aware, that his speeding may cause harm and as a result is liable for any harm he causes. Most unintentional fathers engaging in unprotected sex are, or should be aware, that they may father children and as a result should be liable to maintain their children. However some unintentional fathers may be deceived. Perhaps they are lied to about contraception. Such fathers may have been unaware that they might become fathers and this ignorance was not due to any fault on their behalf. I would suggest such fathers do not have a duty to maintain their children.

1. Lindsey Porter, Adoption is Not Abortion-Lite, Journal of Applied Philosophy, 29(1), 2012.

Moral Arrogance and not Understanding the Holocaust

I have just been reading a particularly interesting posting by Michael Hauskeller concerning Primo Levi’s attitude to the Holocaust. Levi’s attitude is summed up by Hauskeller as follows,

“Perhaps one cannot, what is more one must not, understand what happened, because to understand is almost to justify. Let me explain: ‘understanding’ a proposal or human behaviour means to ‘contain’ it, contain its author, put oneself in his place, identify with him.” (1)

Hauskeller is inclined to concur with Levi and claims that whilst we must know what causes evil, such as the Holocaust, we should not try to understand it. In this posting I will investigate Hauskeller’s claim. I will conclude that if we fail to attempt to understand the Holocaust we can be accused of moral arrogance. I will then suggest such arrogance is dangerous.

Hauskeller supports his claim as follows.

“Understanding is more intimate, it bridges the reflective distance between the subject and the object of understanding. By “understanding” the Holocaust we would acknowledge it as a real human possibility, as something that is understandable for humans to do. But it is important to reject this possibility, to preserve an image of the human that positively excludes it.”

The Holocaust was a great evil and perhaps we could attempt only to know what caused it in order to prevent a similar event ever happening again. Perhaps we could also attempt to regard people like Hitler and Stalin as not really human. My response to such attempts is twofold. Firstly the holocaust was not committed by Hitler and a few of his cronies alone. The holocaust was an evil and it was made possible by a great number of people doing evil. Were all such people animals, sub human or even untermensch in Nazi terminology? Secondly what does it mean to know what caused the Holocaust? Does it simply mean to know what conditions preceded it? Does it exclude trying to understand the thinking of its perpetrators? If it does then I would suggest our knowledge is dangerously limited. I would further suggest if our knowledge of what caused the holocaust is not to be dangerously limited then we must try to understand the human beings who carried it out as well as those who planned it.

Levi says the hatred that caused the Holocaust is not in us; it is outside man, it is a poison fruit sprung from the deadly trunk of Fascism. He goes on to say no normal human being will ever be able to identify with Hitler, Himmler, Goebbels, Eichmann, and others. The implication of the above is such people are not normal human beings. Perhaps Levi is correct and such people are not normal human beings. But nonetheless they are human beings, even if defective ones, and as such share many of the characteristics of normal human beings. Moreover all of so called normal human beings share some of the harmful characteristics of such people, if to a much lesser degree. We all can be cruel, even if it is only the occasional uncalled for cutting remark. I would suggest if we differentiate ourselves completely from such people we might justly be accused of moral arrogance. The reasons for this differentiation are understandable. But nonetheless this arrogance is extremely dangerous. It leads us to the conclusion we have no need to understand such people. But such arrogance also means we fail to fully understand and hence control the harmful characteristics we share with such people. In attempting to preserve a certain image of what it is to be human we fail to adequately understand ourselves.

1.      Primo Levi; 2000; If This Is a Man, and The Truce; Everyman; introduction.

The Reporting of Suicide

The topic in this posting is the reporting of suicide. My starting point is a posting in bio edge . A leading Australian newspaper recently ran some articles chronicling Beverly Broadbent’s decision to commit suicide, see The Age. It appears at the time Beverly was relatively healthy. I will not consider whether Beverly was right to commit suicide here. However at this point I must make it clear I believe some people have the right to commit suicide and in the right circumstances may justify their decision if they do so. The post’s author clearly believes the journalist involved, Julia Medew, acted in an irresponsible way. He points out,

“A journalist is first of all a human being. Didn’t Medew have a moral obligation to dissuade a relatively healthy woman from committing suicide?”

However even if Medew ought to have attempted to dissuade Beverly this does not mean she ought not to have reported the suicide. In this posting I will argue the reporting of suicide is necessary for a better understanding of suicide.

What is wrong with Medew’s story? It might be objected that either the story should not have been reported in the way it was or it should not have been reported at all. I will deal with the latter objection first. An objector might argue such stories should not be reported due to the harm they cause. She might point to evidence that suggests the reporting of suicide leads to copy cat attempts, see for instance Gould, Jamieson and Romer . Because of the harm these copy cat suicides cause she might conclude suicide should simply not be reported at all. In reply I could point out much the same argument could be applied to school massacres and terrorist bombings. Prima facie it would be inconsistent to report these and not report suicides. Moreover it would seem to be absurd not to report events such as the Boston bombings for fear of contagion so why should Medew not report on Beverly’s suicide. My objector might respond that my analogy is flawed. She might point out the Boston bombings are a major story that cannot be ignored whilst Beverly’s suicide was a minor one and as a result could be. In reply I accept that Beverly’s particular suicide was not a major story but suicide in general is an important concern to society. If this were not so why should the World Health Organisation offer guidelines to journalists ?

However let us assume that my objector is correct and that in practice it is impossible to ignore terrorist bombings, such as those in Boston, whilst suicides can safely be ignored. Now provided she believes suicides should not be reported, due to the danger of copy cat cases, does this mean she also believes terrorist bombings should not be reported provided this was possible, as the same dangers of copycat attacks seem to apply. Perhaps the only reason why we ought not to attempt to ban the reporting of terrorist bombings is that we cannot. I will now argue that for terrorism such censorship is wrong even if this is possible. The Provisional IRA carried out a program of terror in Northern Ireland during the troubles. Both the British and Irish governments attempted censorship in the reporting of the troubles. However in Ed Moloney’s view,

“Censorship probably extended the life of the Troubles by as much as a third and that people died unnecessarily because of it. I say this because what censorship did was prevent the media from explaining events fully. One result was that public and government understanding was less than it should have been”, see Irish Censorship .

At this point my objector might point out that the reporting of terrorist bombings is not the same as journalists talking to Sinn Fein. In response I would point out a failure to report on Sinn Fein lead to a lack of understanding. I would then argue failing to fully report terrorist bombings might lead both the public and governments failing to grasp the full importance of these events. I would then suggest this diminished importance would lead to diminished understanding. If we fail to grasp the full importance of something we are less likely to reflect on it fully. Suicide is a problem for society and it is the biggest killer of young men in the UK, see The Guardian . If society is to understand and tackle this problem then it must be aware of the importance of the problem. I would suggest a failure to debate suicide, in an order to obtain a more adequate understanding of its causes, merely perpetuates suicide at its present levels. I would further suggest even if press coverage of suicide increases the cases of copy cat suicide in the short term that in the long term a more adequate understanding of the causes of suicide will lead to a decrease in the suicide rate. If this is so then the harm caused by copy cat suicides due to the reporting of suicide should be more than counterbalanced by a long term drop in the suicide rate.

I have argued it was not wrong for Medew to report on Beverly’s suicide. This brings us back to the first reason for the possible wrongness of her reporting, perhaps she was not wrong to report Beverly’s suicide but she did so in the wrong way. A report usually involves, what happened, the details of how it happened and why it happened. I have argued above if something that happens is not fully reported then we can fail to grasp how important that something is. This failure can lead to an inadequate understanding of the problem. Nonetheless it seems to me the mechanics of how someone commits suicide is not usually necessary to the understanding suicide and hence should not usually be reported. However if we are to understand the reasons for suicide we must understand an individual’s reasons for committing suicide and these should be reported. I would suggest the reporting of these reasons should not be emotive. There should be a separation of news and comment and comment need not be emotive free. If we understand the reasons why someone wishes to or actually commits suicide we might be in a better position to deal with the underlying causes of these reasons. Let us consider the case of the Verbessem brothers mentioned in my previous posting. I accept it is possible that the reporting of the brother’s case might lead to an increase in the number of the deaf blind wanting euthanasia in Belgium. However reporting the reasons why the brothers wanted to die might also lead to more or better centres for the deaf-blind. It follows reporting the brother’s case might well lead to an increase of options available to the deaf-blind, which in turn might lead to a reduction in the number of deaf-blind people seeking to end their lives.

So far I have argued that someone’s suicide should be reported and the reasons for her suicide should also be reported. However it would be a mistake to think all individuals who commit suicide can give reasons for doing so. Some individuals might commit suicide simply because they have a lack of reasons to go on living. Harry Frankfurt would class such persons as wantons (1). I have previously suggested such a person suffers from the unbearable lightness of simply being, see riots and the unbearable lightness of simply being. A wanton is someone moved by mere impulse and inclination and someone to whom nothing much matters. Such a person may well be prone to commit suicide. They may also be prone to becoming terrorists and other violence, see self respect and love. The reporting of suicides could well lead to such persons committing copy cat suicides. Moreover in such cases the reporting of suicides will not lead to any long term decrease in suicide committed by such people. Such people give us reason not to report suicide, or at least to do so in a very limited way.

In the above I have argued that, when someone has a reason to commit suicide, the reporting of her suicide and her attendant reasons, even if it leads to some copy cat suicides, is in the long term beneficial. However I have also suggested that for a certain class of suicidal persons such reporting is harmful. Should then suicide be fully reported? On balance I believe it should, I am however open to persuasion and comments are most welcome.

1. Frankfurt, 1999, Necessity, Volition, and Love. Cambridge University Press, page 106.

Assisted Suicide and the Verbessem Brothers

Belgian twins, Eddie and Marc Verbessem, were euthanized at Brussels University Hospital last December. The brothers had been deaf since birth and had been recently diagnosed with a genetic form of glaucoma that would leave them blind. William Pearce comments that this case appears to mean the following holds in Belgian,

“Death is a logical and reasonable option if a person will become deaf-blind. By logical extension there are some disabilities that are a fate worse than death. One does not need to be terminally ill to be euthanized”, see Hastings Center Bioethics Forum .

In this posting I will argue even if death is a reasonable option it does not mean some disabilities that are worse than death. I will then examine if death is a reasonable option when, if ever, it is permissible to help someone die.

Pearce seems to believe that all voluntary euthanasia is wrong. In the rest of this posting I will assume voluntary euthanasia is roughly equivalent to assisted suicide and only use the latter term. There are of course some differences between voluntary euthanasia and assisted suicide but don’t I believe these differences significantly affect my arguments. Pearce suggests two reasons for the wrongness of assisted suicide. Firstly he points to research in Oregon where assisted suicide is legal which shows most people who chose to end their lives this way did so because of the loss of autonomy or dignity rather than unbearable pain. The implication of the above is he seems to believe loss of autonomy or dignity is not a good enough reason to justify assisted suicide. I agree loss of autonomy is not a reason that can be used to justify assisted suicide. However it is important to be clear what losing autonomy means. Losing the ability to participate in activities that made someone’s life enjoyable or a loss of her dignity is not the same as losing her autonomy. Losing autonomy means someone losing the ability to make decisions based on what she cares about. Secondly Pearce seems to believe that many of the conditions given as reasons for permitting assisted suicide can be alleviated and hence are not reasons that can be justified. For instance in the Verbessem case he points to the lack of skill centres devoted to the deaf blind. In response I would suggest one cannot say someone ought to do something on the basis of something that ought to be. The Verbessem brothers had to decide what to do on the basis of the circumstances that actually prevailed, not on the circumstances that ought to have prevailed. I of course accept it is possible a reason that is now used to justify assisted suicide may cease to be a reason if and when circumstances change.

It might be suggested that the Verbessem brother’s case implies that living with certain disabilities is worse than dying but this is not so. Clearly some people who are deaf-blind want to continue living and do not see this disability as a fate worse than death. Equally clearly some people would like to live as long as possible regardless of any disability or any disease they may be suffering from. It follows that any condition however bad or painful cannot be the sole reason to justify assisted suicide. What matters is someone’s attitude to her condition. For instance someone suffering from painful terminal cancer might just wish to die whilst someone else suffering from the same cancer might wish to continue living, perhaps for religious reasons. It would appear to follow what matters is someone’s attitude to her condition caused by disease or disability. It further follows assisted suicide is really being justified by someone’s preferences. However because, we do not have a reason simply to satisfy all of someone’s preferences, satisfying her preferences cannot be used to justify assisted suicide. It still further follows that Pearce is correct and neither loss of autonomy nor any condition, however awful someone suffers from, can be used to justify assisted suicide.

It seems to be if we can justify suicide that we should be able to justify assisted suicide. Clearly we have the capacity for rational agency. Joseph Raz argues we also have a duty to respect the exercise of this capacity by others within certain bounds because we value this capacity. Moreover he believes this exercise includes the option to determine when and how to end one’s life and that others may help us implement this option (1). I now want to consider two objections to Raz’s position. Firstly someone might object that euthanasia is not part of a rational person living her life. Raz might reply a rational person might nonetheless value she has the option to end her life, if it became meaningless and full of pain, whilst living her life. He might point out if someone values a right and the exercise of this right does not significantly harm others that we should respect her right. This could be classed as Mill’s position.

I now want to examine what is meant by significant harm in more detail. Firstly the fact that someone is offended, simply by another’s decision to commit assisted suicide, is not a great enough harm for her to fail to respect the other’s decision. The fact that someone is offended by another’s political views should not mean she fails to respect the other’s capacity to express these views. Nonetheless there are certain harms that would sometimes make the exercise of assisted suicide wrong. For instance it would seem wrong for a mother with dependent children to be able to be assisted to commit suicide. Or an aged parent who enjoys life but in spite of this enjoyment chooses to end her life solely to ensure her estate passes to her children rather than being dissipated on her care. However such examples don’t show assisted suicide is always wrong. They merely show, as Raz suggests, there are bounds as to when assisted suicide is permissible.

Should assisted suicide always be impermissible because of the harm it may inflict? In what follows I will argue assisted suicide should only be impermissible in specific cases due to specific harm relevant to the case in question. Let us accept that a complete ban on assisted suicide would prevent harming people such as those in the above examples. However I would suggest a complete ban on assisted suicide would also harm other people. For instance if someone who is terminally ill and in great pain, has no relatives, wishes to commit assisted suicide is prevented from doing so she is harmed. She is harmed not by the failure of society to permit others to help release her from the pain, someone else might well want to continue living even with the same degree of pain. She is harmed in two ways. Firstly she is harmed because society prevents her attaining something she values. Secondly and more importantly in my view she is harmed by the failure of society to recognise her as an agent. In this case she values something, which harms no specific person, but is nonetheless prevented from seeking what she values. It follows a complete ban on assisted suicide would harm some people. It further follows some assisted suicide is permissible.

The above suggests if all assisted suicide is impermissible some people would be harmed and if all assisted suicide is permissible others would be harmed. How is society to decide on which cases are permissible and which are not? I would suggest this decision should firstly be based on harm to others. I would further suggest this harm must be to those who depend on the person who wishes to commit assisted suicide, basically family members. However not all harms to family members make assisted suicide impermissible. Consider an aged woman, suffering from a painful terminal condition, who only has weeks to live. She wants to be assisted to commit suicide. In addition she is also a much loved mother and her adult children do not want her to commit suicide. However her children are not dependent on her any more and even if they will be harmed by her death I would suggest such harm is not so great to make her assisted suicide is impermissible.

Let us assume it is permissible for an autonomous person to commit suicide. If suicide is permissible for an autonomous person why should it be impermissible for someone to aid her to do so in some cases? In order to answer this question I will first consider what means to make an autonomous decision. An autonomous decision is not simply a rational decision. The rationality of a decision depends on how well it achieves the agent’s goals. In this blog I take a position similar to that of Harry Frankfurt. Autonomous decisions are decisions based on what an agent ‘cares about’. Caring about and autonomy are central to being a person.

“Can something to whom its own condition and activities do not matter in the slightest properly be regarded as a person at all. Perhaps nothing that is entirely indifferent to itself is really a person, regardless of how intelligent or emotional or in other respects similar to persons it may be” (2).

However sometimes someone may not be fully aware of what she cares about. She might make a decision based on what she believes she cares about but when she comes to implement her decision finds she cannot. Sometimes what someone cares about is shown more by her actions rather than her decisions. Accepting the above provides a reason as to why even if it is permissible for someone to commit suicide it is sometimes impermissible for others to aid her do so. Someone may make a decision to commit suicide but be unable to implement her decision. Accepting the above suggests if assisted suicide is ever permissible it is only permissible if someone makes an autonomous decision to commit suicide and is unable to implement her decision by herself. It further suggests if voluntary euthanasia is ever permissible it must be so only under the above conditions,

Does the greater certainty that someone’s actions are autonomous compared to her decisions mean we can never justify assisted suicide even for someone who makes, what we believe to be autonomous decision to commit suicide, but lacks the capabilities to implement her decision by herself. I accept that the conditions in which assisted suicide might be permissible are far ideal. Nonetheless even if these conditions are far from ideal I believe assisted suicide is permissible if someone makes a decision to commit suicide and is unable to implement her decision. My belief is based on centrality of autonomy to our lives, of seeing ourselves as capable of determining our own future. I would assume anyone who believes we should not permit assisted suicide does so for beneficent reasons. She believes in acting beneficently has priority over respecting autonomy, at least in this scenario. Some proponents of assisted suicide argue that, because we would not let animal suffer as we do some persons in some cases, we should permit assisted suicide. I have argued above that suffering alone does not provide a basis to justify assisted suicide. Nevertheless in much the same way I would suggest those who place greater emphasis on acting beneficently over respecting autonomy see persons in much the same way as they see animals. They fail to see, or only pay lip service to seeing, others as creatures who can determine their own future, see respecting autonomy and a flourishing society .

Accepting the above has three important practical consequences. Firstly, because our certainty about autonomous decisions is less than our certainty about autonomous actions, we must be extremely careful about assessing autonomous decisions. Unfortunately if autonomy is essentially a matter of someone’s will rather than her rationality this is far from easy to do. I have previously suggested this involves assessing someone’s satisfaction with her decision, see valid consent . Secondly it seems to me Brussels University Hospital can justify offering the Verbessem brothers assisted suicide. Provided the Verbessem brothers had made an autonomous decision to commit suicide which they could not implement. I am assuming in the above that anyone who is both blind and deaf would have difficulty in committing suicide. I do not deny that had there been more skills centres for the death blind might available to the brothers that they might have made a different decision. Unfortunately as I have argued above they had to make their decision in the light of circumstances in their case. Lastly and perhaps even more controversially assisted suicide might be offered to a broader domain of people than just the terminally ill. I have suggested myself that assisted suicide might be permissible for prisoners serving life sentences, see prisoners serving life sentences .

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1. Joseph Raz, 2013, Death in Our Life, Journal of Applied Philosophy, 30(1).
2. Frankfurt, 1999, Necessity, Volition, and Love, Cambridge University Press. Page 90.

The Obese and Two Types of Shame

Daniel Callahan calls for an “edgier” strategy in order to reduce obesity levels in the United States (1). One element of his suggested edgier strategy would be to put social pressure on the obese. One way of putting social pressure would be to shame the obese. I have argued in a previous posting that shame could play a greater part in regulating our society and that this regulation might reduce the need for some legislation, see guilt shame and society . It might appear that I should support employing shame, however I am reluctant to do so for three reasons.

Firstly as Susan Apel points out it is important how shame is directed. It should be directed at the behaviour that leads to obesity rather than directed at the obese. It follows we must be careful when employing shame. Secondly Apel argues shaming must produce weight loss. Apel quotes her own personal experience of weight gain after having had cancer and going through the menopause. Clearly it is wrong to shame someone about her weight even if this is effective in altering her altered behaviour but produces weight loss. My third concern questions some of our underlying motives in shaming the obese. Lastly I will suggest that if we do exert social pressure on the obese that we should employ guilt rather than shame.

Let us now consider my first concern. What is shame is directed at. What do we mean by shame? Velleman defines shame as “anxiety about social disqualification” (2). It is possible that in a hunter gatherer society someone who was born crippled might feel shame due to his inability to play an active part in the tribe. Using Velleman’s definition it is also possible that someone who is obese due to some genetic condition might feel shame in our society. It might be objected no one would actually feel shame if his being obese was really due to a genetic condition. Unfortunately people may well feel such unwarranted shame. For instance when my father lost his sight as he aged he not only worried about his difficulty in seeing, but he also worried about others being able to see his difficulty. It appears to follow if we want to encourage shame in order to counteract obesity in our society we must direct our shame at the behaviour of the obese rather than the obese themselves. In practice it might prove to be difficult to direct our disapproval purely at someone’s behaviour without involving the person. For this reason it might be thought we should try to encourage guilt rather than shame. What is the difference between guilt and shame? Shame as defined above is unease with about social disqualification and disqualification requires an audience. Guilt is unease with something one has or has not done and can be private. Unfortunately, as with shame it is possible to feel unwarranted guilt. For as Velleman points out someone who has done nothing wrong may feel survivor guilt for having survived some catastrophe that has killed others (3).

It might appear that there are reasons not to encourage either guilt or shame when attempting to combat obesity. However, I would suggest the usual definition of shame fails to fully capture our intuitive ideas about shame. Perhaps there are really two types of shame. Firstly we might feel a natural shame given to us by evolution. This type might have helped our hunter gatherer ancestors to form cohesive groups. Is any other type of shame possible? Could Robinson Crusoe feel shame? In other words is private shame possible? Perhaps any shame felt by Crusoe would have been based on the culture he grew up in nonetheless I would suggest his shame was private shame. The second type of shame might help to form us to be persons, to be authentic. Velleman suggests guilt might be connected to someone’s conscience (4). Shame might also be defined as someone’s anxiety about harming the things he cares about or loves and is linked to character. Perhaps the second of this second type of shame should be encouraged in order to combat obesity and other social ills. This second type of shame is connected to what someone loves. Loving as usual in my postings simply means to ‘care about’. I would now suggest that this second type of shame acts as a guardian of what someone loves. Let us assume someone loves something. If what he loves is harmed and he could have done something to prevent this harm and he feels no shame then I would question whether his love was genuine love. It might be objected that the second kind of shame defined above isn’t really shame and should be classed as guilt. In response to my objector I would point out guilt is linked to a specific event. Type two shame as I have defined it is linked to what we love and what someone loves defines what kind of person he is. Type two shame is connected to someone’s character and as a result differs from guilt. Type two shame seems of necessity to be directed at a person and cannot simply be directed at someone’s behaviour. If we employ the second type of shame in order to combat obesity we are shaming obese persons rather than directing shame at their behaviour.

Let us now address my second concern is shaming the obese effective in reducing obesity. Clearly we ought not to shame the obese if this is ineffective. If I do something which on later reflection I consider as wrong I can change my behaviour and apologise. It therefore makes sense to point out to someone that his action is wrong or misguided. If we shame someone in the second sense of shaming we are pointing out to someone that there is something wrong with their character. But people can’t just change their character at will, if they could they wouldn’t really have any character at all. Perhaps people can change their character over time but this is a slow process. It follows if we shame the obese using this second type of shame that they are more likely to withdraw from us rather than engage with us and lose weight. Shaming the obese is unlikely to help the obese in the short term.
Let us now consider my last concern. It might be argued that sometimes when we engage in shaming our motivation is not solely to change the behaviour of the shamed. It might be argued that sometimes when we shame others we do so in order to massage our own egos, even if we aren’t aware of our motivation. Perhaps when we shame the obese we are unconsciously massaging our egos. If our motivation in shaming the obese is at least partly to massage our egos then shaming is wrong because we are using the misfortune of others to serve our own ends.

I have argued that it would be wrong to employ shame in order to reduce obesity. However obesity is a major problem and we should address it through education. Might we also apply social pressure as suggested by Callahan by fostering guilt? I argued above that one reason why we should reject shaming the obese is that the shame is directed at their character rather than their behaviour. Trying to make someone feel guilty is directed at specific actions. Guilt might be defined as anxiety about social approbation concerning a specific action. Nussbaum suggests that if we disapprove of some action we should separate the doer from the deed. (5) Fostering a sense of guilt achieves this. For instance guilt might be directed at someone’s lie whilst shame would be directed at someone being a liar. Perhaps we should direct our disapproval at the amount of food someone eats or his lack of exercise rather than at his being obese. However in doing so we must be cautious for it isn’t always easy to separate the deed from the doer.

1. Callahan Daniel, 2013, Obesity: Chasing an Elusive Epidemic. Hastings Center Report, 43, pages 34–40.
2. David Velleman, 2009, How We Get Along, Cambridge University Press, page 95.
3. Velleman, page 99.
4. Velleman, page 101.
5. Martha Nussbaum, 2018. The Monarchy of Fear, Oxford University Press, page 217

Moral Character Enhancement and Moral Status

Intuitively most people seem to believe that provided we could morally enhance people it would be a good thing to do so. After all this is exactly what moral education is trying to do? In the age of Trump and his supporters the question of moral enhancement assumes greater importance. Many people also seem to think that provided this enhancement could be done by pharmaceutical means without any adverse side-effects that it should be attempted. Ingmar Persson and Julian Savulescu support these intuitions and in addition argue there is an urgent need to enhance the moral character of humanity, see Persson and Savulescu. However Nicolas Agar argues that whilst it may be possible to enhance moral status that it would be wrong to do so, see Agar. Moral enhancement has two aspects, the enhancement of moral character and the enhancement of moral status. In this posting I will assume it is possible to enhance the moral character of people. I will firstly examine whether character enhancement need be linked to moral status enhancement. I will secondly examine whether, provided character enhancement is of necessity connected to the enhancement of moral status, any such character enhancement can be justified.

Before commencing my examination I must make an attempt to make some definitions clear. Firstly what is meant by enhancing the moral character of someone and secondly enhancing her moral status? Let us accept without argument that enhancing the moral character of someone means improving the ways she acts with respect those things that have moral status. To Agar for something to have moral status means someone has certain rights which others must respect. It follows to enhance moral status would simply mean to increase her rights. Agar sees these rights as meaning something is entitled to certain forms of beneficial treatment and a reduction in its eligibility for certain forms of harmful treatment. I would question whether Agar’s definition of moral status is a complete one. Of course someone’s moral status contains rights about her entitlement to benefits and her eligibility for harm but might it not also include respect for her knowledge concerning moral questions. I would argue such respect must include understanding. If we respect someone for her moral knowledge then we respect her because she can point us in the right direction. We respect her because she can highlight some of the important features attached to our moral understanding or give us an example which might make things clearer to us. We should not respect someone who simply tells us to do something for moral reasons if after some effort we cannot understand these reasons. To respect someone’s moral status because of her superior moral knowledge means we must be able to understand her moral reasoning even if she has to draw our attention to this reasoning.

There are four questions attached to moral enhancement. Firstly why should we enhance moral character? Secondly how can we enhance moral character? Thirdly why should we enhance moral status? This seems to be the question Agar is concerned with. Lastly how can we enhance moral status? Let us assume for the moment that there is no need to answer the first question for we accept the need for moral education. It appears provided there are no unforeseen adverse consequences that it is always good to enhance moral character. Improving our moral character, like improving our happiness, is always good. Let us also assume there is no need to answer the fourth question provided we accept Agar’s definition of moral status. To increase someone’s moral status we simply increase her rights to certain beneficial treatment and decrease her eligibility for certain forms of harmful treatment. If we accept the Agar’s definition then we are left with two important questions concerning moral enhancement. How can we enhance moral character and why should we enhance moral status? Prima facie the reasons why we should we enhance someone’s moral status seems to be unconnected to how we could enhance her moral character. It appears to follow if we enhance someone’s moral character that this enhancement should not affect her moral status.

Such a conclusion would be premature for it might be the way in which someone’s moral character is enhanced automatically leads to an increase in moral status. If this is so we must be able to justify an increase in moral status if we are to justify character enhancement. There are two ways in which someone’s moral character might be enhanced. Firstly her cognitive abilities might be increased. Secondly her capacity for empathy might be increased. If someone’s cognitive abilities could be increased it might be thought that this increase would increase her ability to understand moral problems and help her to resolve them. I’m doubtful whether cognitive enhancement alone will actually lead to moral character enhancement. For instance someone might simply use her increased cognitive abilities to exploit others. It is only when her increased cognitive abilities are directed at moral problems that this increase might actually lead to moral enhancement. Nonetheless let us put my worries to one side for the moment and assume that cognitive enhancement alone can lead to moral enhancement. Does the moral enhancement of the character, by increasing people’s cognitive abilities automatically increase their moral status? It might do so provided respect for greater moral understanding is part of moral status as I have suggested above. But such an increase in moral status based on respect would not affect the entitlement of any of the things of moral concern to certain forms of beneficial treatment or lead to any reduction in their eligibility for certain forms of harmful treatment. It follows it would not be wrong to enhance someone’s moral character, by increasing her cognitive abilities, provided this increases her moral status based solely on respect.

However let us assume the moral enhancement of someone’s character, by increasing her cognitive abilities, would also enhance her moral status by increasing her entitlement to certain forms of beneficial treatment and further reducing her eligibility for certain forms of harmful treatment. Would such an enhancement of moral status be wrong? Someone might suggest such enhancement would create two kinds of moral status for people. People whose character has been enhanced, which means they are entitled to additional beneficial treatment and a reduction in their eligibility for certain forms of harmful treatment, and those who are not. She might proceed to suggest that the creation of two kinds of moral status for people would be wrong. Let us consider her first suggestion. Will moral character enhancement by increasing cognitive abilities lead to the creation of two kinds of moral status? I am doubtful. Let us assume that cognitive enhancement can be achieved by biomedical means or genetic engineering. If cognitive enhancement is to lead to the creation of two kinds of moral status then these means must not be available to all. However it is far from clear that these artificial means will not be available to all for technology moves at a very fast pace. Moreover even if these means become only available to a few, the fact that these few are cognitively enhanced should mean these means should in time become available to all. My objector might retort that the few who are cognitively enhanced will not spread these means to others and instead will exploit them. In reply I would simply point out we are only concerned with cognitive enhancement connected to the moral enhancement of the character and that because of this, this sort cognitive enhancement should not lead to the exploitation of others. Exploitation is incompatible with moral enhancement. It appears probable that if the cognitive enhancement of character does lead to an increase in moral status that this increased status will eventually apply to all. It further appears that even if enhancement leads to two types of moral status for people that worries about exploitation are unjustified.

Let us assume that the moral enhancement of the character, by increasing someone’s cognitive abilities, does produce two kinds of moral status for persons. My objector assumes this is wrong. What reasons could she advance for this wrongness? Firstly she might suggest that those of increased moral status would have their entitlement to certain forms of beneficial treatment increased and their eligibility for certain forms of harmful treatment reduced, whilst the entitlements of those of lower moral status would remain the same. She might then further suggest that this disparity is unfair. In reply I would question whether those of lower moral status have the right to deny those of higher moral status increased entitlements provided their own entitlements remain the same. Allen Buchanan makes the same point (1) and asks if we would be justified in delaying India’s development in order to allow Ethiopia catch up. Secondly my objector might suggest in a world of scarce resources that those of lower moral status would be given less of these resources; that is their entitlement to certain forms of beneficial treatment would be reduced and their eligibility for certain forms of harmful treatment increased. In reply I would simply reiterate that such a state of affairs would be one of exploitation and that the moral enhancement of character should preclude increasing the exploitation of others.

My objector might now suggest cognitive enhancement cannot simply be tied to the character enhancement as I have assumed above. She might then suggest that cognitive enhancement can be tied to both character enhancement and exploitation. She might proceed to argue what really matters is what someone’s increased cognitive abilities are directed at. I have myself suggested above that the cognitive enhancement of someone’s moral character can only occur if cognitive enhancement is directed at moral problems. It follows I must accept my objector’s suggestion that cognitive enhancement cannot simply be tied to the character enhancement. I must also accept that purely cognitive enhancement might lead to exploitation of the un-enhanced by the enhanced. It also follows that if the cognitive enhancement of moral character is to be justified that any increased cognitive powers must be directed at moral problems in some way. The way to achieve this direction I would suggest is to increase our capacity for empathy.

Let us assume that we can enhance someone’s moral character by increasing her cognitive powers and by directing at least some of this cognitive increase towards moral problems by increasing her capacity for empathy. Let assume such dual enhancement also increases her moral status. Could such a dual enhancement lead to exploitation? Exploitation of the un-enhanced by the enhanced would mean, either that their entitlement to certain forms of beneficial treatment would be reduced and their eligibility for certain forms of harmful treatment increased, or that their entitlement is not increased and their eligibility not reduced even when this is possible. However so doing seems incompatible with an enhanced capacity for empathy. For if the enhanced reduced the entitlement of the un-enhanced to beneficial treatment then we might question if their capacity to feel empathy really had been increased. It follows dual enhancement does not mean that the entitlement of the un-enhanced to beneficial treatment would decrease or their eligibility for harm increase. Indeed dual enhancement might mean their entitlements might increase and their eligibility decrease. The above leads me to tentatively conclude dual enhancement can be justified even if it leads to the un-enhanced people having a lesser moral status than the enhanced.

At this point someone might suggest that because of the dangers of exploitation we should only attempt to enhance our capacity for empathy. I would reject such a suggestion. Consider a paedophile who uses some artificial means to increase his capacity for empathy. This increased capacity for empathy does not rid him of his urges but it does allow him to resist most of them. Indeed this increased capacity for empathy might be regarded as a form of moral enhancement. However let us consider the unlikely possibility that the abuse of this paedophile commits does not physically harm a child. Let us further assume he comes into contact with a child who is a willing participant and even enjoys the encounter. It would seem in this case he has no reason not to abuse the child. It follows that moral character enhancement based solely on empathy is compatible with this abuse. Increasing someone’s cognitive abilities allows him to better understand the concepts of autonomy and consent and would help prevent such abuse. It follows the enhancement of someone’s cognition and empathy is preferable to moral enhancement based solely on increasing someone’s capacity for empathy.

1. Allen Buchanan, 2011, Beyond Humanity, Oxford University Press, page 53.