Archive for June 2006

Justifying the Means

June 11, 2006

Do the ends justify the means? This is one of those questions that drives philosophers crazy, since there are always some ends that seem great enough to justify immoral behavior. The more comprehensive a philosophy is, the greater the chances that it will say yes to the question. This is based on the assumption that good intent can outweigh any negative consequences. The more internally consistent a philosophy is, the greater the chances it will say no. This is based on a type of dogma that provides absolute guidance regardless of context. So philosophers have a choice to make early on, which is how comprehensive their philosophy will be versus how internally consistent it will be.

As usual, I am going to split the middle and say that some ends can be justified by immoral means, but the standard for doing so needs to be set very high. For example, undercover agents are constantly being recruited by law enforcement. These are very bad people who provide information to the police, put high profile criminals behind bars, and generally help with keeping the overall crime rate under control. If this relationship is not carefully maintained however, there can be a huge cost to the integrity of the police. Moral hazards are a constant risk in these types of situations, and it takes a careful officer to know when the line has been crossed.

A few types of political philosophy, including Plato’s, are based on a concept called the noble lie. This is a lie told to the public to keep them subservient to the ruling class. In theory, it is supposed to be used only for the superior purposes of enhancing the public good, but of course it is actually used to cover up corruption and abuse. Which brings me in roundabout way to my second point, which is that the higher up the governance ladder you go, the more important it is to make a presumption in favor of transparency.

Mercy and Futility

June 6, 2006

I held off on writing this post because it is a very difficult subject. Much more difficult than abortion, even. There are slippery slopes just about everywhere and you have to be very careful about setting limits. There are multiple factors in play, and it is necessary to keep a careful eye on which ones are important in different contexts.

In the first context of active consent, euthanasia is already being done under the table, so to speak. Any patient has the right to refuse treatment and to receive palliatives. Many, if not most doctors will prescribe ever increasing doses of morphine in these cases until the patient dies.

In the context of futile care, there are two variations to consider. In the first, the patient has filled out a living will or left instructions with their family on how to handle both emergency care and life-sustaining treatment over a long time frame. A living will is many times more preferable than instructions with a family member. As numerous court cases have shown, family members can be ghoulish enough to betray the wishes of their own blood in order to receive an inheritance. Even when they are acting in good faith, unless everybody in the family was given the same instructions, there will be disagreements and confusion.

The second variation of futile care is much more dangerous, as it involves taking the choice away from the patient and bestowing it upon a group of doctors who make a medical decision about quality of life. In no case should this ever be used for a patient, (and by extension their family), who can pay the medical bills. Only when the patient is literally dependent on charity from the hospital to sustain life should the doctor’s opinions even be allowed to count. What is truly insidious about this new practice is that it relieves a huge financial burden on the insurance companies, who will always push for ways to get out of their legal contracts. With more and more insurance only paying a portion of the cost of care, once it gets beyond a certain threshold they will have reasons to encourage the hospital to declare treatment futile and in turn use this decision to deny any further claims from the patient. This places far too much financial risk on the patient. Any state that permits this futile care law to operate should also prohibit any drop in insurance coverage based on that decision, as this would restore some of the balance of risk.

With all of these methods and contexts, it is important to keep in mind that the wishes of the patient should be the paramount concern. Euthanasia should in fact be a mercy, and not a way to dispose of the weak or unwanted. Too many cases have been reported of doctors who take matters into their own hands, subverting the will of the patient and her family. Nor should it be abused by the patient in a moment of depression or doubt, which is why there should be mandatory counseling for anybody who gives their active consent. I would even go so far as to deny pain medication for a day or two, in order to make sure that their decision is competent and to see if pain can reassert the natural fight for life response.

In unfortunate cases like Terri Schiavo’s , where there is a minuscule chance of not being in a PVS, the appropriate course to take is the one that was taken. Giving her body one last chance to resist and challenge the threat of starvation was the only way to determine if anything remained of her mind and consciousness. Of course, in that particular case, her husband Michael acted in a most selfish manner by not transferring guardianship to her parents. His immoral behavior notwithstanding, the method of euthanasia used in her case was correct.