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Great Ideas of Philosophy

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Lecture Fifty-SixMedicine and the Value <strong>of</strong> LifeScope: The arena in which moral theories vie for credibility is that <strong>of</strong> real life, where the stakes are high and theproblems seldom simple. This is especially the case in medicine, where life-and-death decisions are madedaily and where <strong>of</strong>ten it is the lesser <strong>of</strong> two evils that exhausts the choices. What guidance does moralphilosophy provide in this domain? Illustrative cases can be examined as they would be informed byutilitarianism or by deontological moral theories. It becomes clear that neither <strong>of</strong> these dominant moralperspectives easily disposes <strong>of</strong> the actual cases confronted by physicians. Distinctions between killing andletting die, between letting die and assisting in suicides, between doing good with evil nonetheless foreseenand doing evil are examined. It becomes clear that there is no reliable unit <strong>of</strong> value with which todetermine the value to be set on life. Nor are there easy answers to questions about which lives are to besaved and which forfeited under realistic conditions. In the end, moral philosophy is not really developedto the point <strong>of</strong> settling such matters, its proper function being the identification <strong>of</strong> the principles that seemto be at work as decisions are made.OutlineI. There are three dominant schools <strong>of</strong> moral philosophy.A. One <strong>of</strong> these, beginning as a theory <strong>of</strong> the moral sentiments, Hume’s moral theory, lays the foundation forutilitarianism based on the goal <strong>of</strong> optimizing pleasure and minimizing pain.B. Aristotelian “perfectionist” theories absorb the moral domain into that <strong>of</strong> character itself, where thedecisive factor is the manner in which one’s actions accord with the dictates <strong>of</strong> reason.C. On Kantian deontological grounds, morality arises from the autonomy <strong>of</strong> a rational being free to decide, toobserve, or to defy the moral law. Kantian moral theory focuses on the intentions <strong>of</strong> the actor, not theconsequences <strong>of</strong> the action.D. General theories <strong>of</strong> this sort are “abstract” in that they do not <strong>of</strong>fer long lists <strong>of</strong> the actions required orforbidden by the terms <strong>of</strong> the theory. They do provide a framework within which to weigh significantactions for their moral worth.II. All moral theories place a premium on actions capable <strong>of</strong> causing great harm to the innocent; thus, one <strong>of</strong> therichest arenas in which to test the applications and implications <strong>of</strong> competing theories is medicine. Ourwillingness to favor a given moral theory depends partly on whether, in concrete cases, it calls for actions thatappear to be sound and justified, if not obligatory, or whether it seems to allow actions many would reasonablyregard as unacceptable.III. From a moral point <strong>of</strong> view, there are a variety <strong>of</strong> questions surrounding the taking <strong>of</strong> a life, including how onelife may be valued as worth more or less than another, in different situations.A. With suicide, there is no complication arising from proxy decisions, nor is the judgment <strong>of</strong> the value <strong>of</strong> thelife in question reserved to any party except the person whose life it is.1. Kant argues that suicide is a moral wrong because the grounds on which such an act would bechosen—to create or change a state <strong>of</strong> feeling—entails using a rational being (oneself, in this case) asan instrument to bring about some desired state <strong>of</strong> affairs.2. On the other hand, the ancient Roman Stoic Seneca says in his essay On Fear that a debilitatingdisease, for instance, would rob a person <strong>of</strong> the very dignity Kant accords rational beings.3. Hume contends that God presumably gave human beings the power <strong>of</strong> free choice in order to promotetheir happiness and well-being and that both <strong>of</strong> these objectives may be best met by ending a life <strong>of</strong>misery and torment.4. In his libertarian and utilitarian philosophy, John Stuart Mill places the freedom <strong>of</strong> the individual as ahigher value than the paternalistic concerns <strong>of</strong> those who would thwart individual efforts and aims.Accordingly, the morality <strong>of</strong> suicide is to be weighted according to the utilities associated withcontinuing or ending a life <strong>of</strong> pain and misery.B. <strong>Great</strong> controversy has surrounded the question <strong>of</strong> physician-assisted suicide.©2004 The Teaching Company Limited Partnership 23

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