Intentions Matter

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Young man crossing a flooded street in an Indian slum. Photographer: Thomas Leuthard.

In a recent column by Oliver Burkeman for The Guardian on why profiting from giving isn’t always bad, he said that “starving refugees care about food and shelter, not motives.” In essence, he takes an old consequentialist position – doing the right thing for the wrong reasons (or even just partly) is just as good as doing the right thing for the right reasons if the outcomes of both actions are indiscernible. There’s just one problem here though: the outcomes are not indiscernible, and starving refugees care about motives more than food and shelter, even if they don’t know it themselves.

Famous in the field of moral philosophy is the doctrine of double effect. Take the classical example of comparing a terror bomber and a strategic bomber. The terror bomber intends to kill civilians to weaken the enemy’s resolve while also destroying military targets. Contrast this with the strategic bomber who intends to only destroy military targets but foresees that he will also kill civilians in the process. Most would consider the terror bomber to have acted in a less ethical way than the strategic bomber, even if they both kill exactly the same number of civilians and destroy the same military targets.

As a utilitarian myself – someone who is interested in maximising the happiness and utility of sentient beings – I am presupposed to fall under the traditional consequentialist spell of somehow denying that the terror bomber is a worse person than the strategic bomber. After all, their actions were exactly the same, and had the same consequences. Aren’t I then going against my basic ethical tenets to say that one act is worse than the other? Well, yes, but only if I think about the short-term and think about individual acts (such as bombing military targets or giving to charity) in isolation of likely future acts.

After the bombing, suppose both the strategic and terror bomber return to base and the next day are sent out on another mission. This time they must survey a village to look for military targets but not bomb. Suppose that both bombers find no military targets, just civilians. If the same intentions and motivations still exist in both bombers as in yesterday’s bombing run, we can see that their actions will be very different. The strategic bomber will return to base with just as many bombs as he left with, whereas the terror bomber will have massacred as many citizens as possible. Clearly, then, although his first act had the same consequences as the strategic bomber, his future actions are dissimilar in a dramatic fashion.

In the same way, Bono giving money to boost his ego or public image (if that is what he is doing) is not helpful to starving refugees in the long-term. Yes, it might be just the same amount of food and water he would give if giving from purer motives, but what if he is presented with a scenario in the future in which his ego will lead him to do something bad or not quite as good as he might have otherwise. Say, for example, that he is given the opportunity to give to two charities. One charity says it can save a life for every $4,000 Bono gives to it, and the other charity says it can save a life for every $3,000. If acting out of compassion or with the intention of helping as many people as possible, Bono would probably choose to give to the latter charity who will save more lives. But what if that charity is unwilling to participate in any media or marketing with Bono and the charity who will save less lives say they will put on a big party and press conference, gaining lots of media attention. What will Bono choose then? His ego might lead him to save fewer lives.

Of course, I don’t claim to know Bono or his intentions. His motives might be perfectly pure and he certainly has done a lot for many people in need. However the intentions of our actions and our motivations to act matter a lot more than Oliver Burkeman claims in his column. Indeed, more starving refugees might be saved from death and disease if we rid ourselves altogether of egotistical influences in our giving to charities. In other words, no, if starving refugees have an interest in food and shelter then they have an even bigger interest in the intentions behind that giving.

Australia’s dying dignity

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An empty hospital bed. Photographer: Elo Vazquez.

“If I were to keep a pet animal in the same condition I am in, I would be prosecuted. If you disagree with voluntary euthanasia, then don’t use it, but don’t deny the right to me to use it.”

Those were some of the last words of Robert Dent, a Northern Territorian who suffered a long battle with prostate cancer until he became the first person in the world to be euthanised under a statute law. He passed away peacefully on the 22nd of September, 1996. But few fellow Australians have been legally afforded the same mercy. In a rare reminder of the territories’ sovereignty-status, the federal Parliament responded months later by passing laws to overturn those created by the government in the Northern Territory which allowed physicians to assist those who wished to die. Since then, thousands of people have suffered slow, miserable deaths where they otherwise might not have wanted nor needed to.

One such person was Laurie Strike, who passed away in Perth last month after suffering a lengthy treatment for terminal cancer. Earlier this year, he had appealed to the public and our politicians to legalise voluntary euthanasia.

Although the Western Australian parliament have not debated the issue since 2010, other state parliaments have had more recent legislative proposals. Before the state election in Tasmania, voluntary euthanasia legislation was narrowly defeated despite favourable public opinion polls. In South Australia, independent MP Bob Such had, in 2012 and 2013, drafted a private members’ bill for voluntary euthanasia. Before the state election, he admitted that his quest was unlikely to be successful, though given his new political leverage in the hung parliament his chances may improve. (Sadly, however, in macabre irony, he has recently fallen seriously ill.) Religious groups and others opposed to euthanasia have vigorously lobbied legislators on all occasions.

So why do anti-euthanasia campaigners force people like Mr Strike to suffer? Many would appeal to human rights, such as the OHCHR’s International Covenant on Civil and Political Rights. Article 6(1) states that: “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life.”

One moral argument is that Mr Strike shouldn’t have been able to die with a physician’s assistance, since he was a human being and therefore had a right to life which, in this case, would not have been protected. However this ignores the very essence of what we mean in this context when we talk about a ‘human being’. In fact, merely belonging to a particular species of animal, Homo sapiens, is rather meaningless in moral terms. It’s truer to say we value the presence of particular qualities in human beings more than we value membership to a particular species. Do we really hold that the value of a human being is the same if we compare someone who is permanently brain-dead and someone who is not? Most would consider the brain-dead human being to actually be dead, despite the fact that, in medical terms, the organs and tissue are being kept alive. Clearly, then, when people judge the brain-dead human being as dead, they are actually judging the capacities and qualities of that human being: their ability to communicate, to understand their surroundings, to find enjoyment in life, and so on. All these things come with being a person, not merely a human being.

It is truer, therefore, to say that every person has the inherent right to life, not that every human being does. Though if Mr Strike was a person, then doesn’t the same problem raised by those opposed to euthanasia remain? Aren’t we still depriving him of life or failing to protect his right to life? The Australian Human Rights Commission, upon examining the euthanasia laws passed by the Northern Territory in 1996, say “no, it does not violate our human rights“. They came to this conclusion partly for two reasons: first, the 1996 legislation had limited scope (it only applied to terminally-ill patients who wanted to die); and second, extensive statutory safeguards were put in place to prevent abuses (protecting patients who did not want to die).

However, even if we didn’t accept this finding, how is it that we can say to have established a ‘right to life’ without giving individuals a right to control their life, including how it ends? A ‘right to life’ cannot be meaningful if one cannot exercise that right in ways which make it, in the full sense, a ‘life’. Said differently, what good is a life you don’t have power over? Or one in which you suffer unbearably, hopelessly, and without any or much enjoyment? These might fall under the literal definition of a ‘life’, but to say that they all, irrespective of their features, have the same quality is to deny the factual differences. To further say that individuals must accept what others ascribe to them as the values which constitute a life – or, as is sometimes said, a life worth living – is to say that you know how to live someone’s life better than they do. While we might be able to argue for this in the case of children, how can we reason the same for a fully mature, capable adult of sound mind? Simply, we can’t.

For this reason, some of those opposed to legalising voluntary euthanasia might agree that perhaps euthanasia itself isn’t necessarily immoral, but rather in legalising it we risk abuses and these risks outweigh the benefits. This should be a concern of any responsible community wishing to legislate on these issues, but is largely an empirical question. Being that this matter is far from uncontroversial it is unsurprising then to find a multitude of interpretations of what data is available to us regarding abuses of voluntary euthanasia laws. That said, almost all authors admit two things: (1) that we can never eliminate one hundred percent of the risk; and (2) that some level of risk can be mitigated by legal and practical safeguards. The question is whether enough of the risk can be prevented so as to justify the benefits. We can’t always stop the occasional corrupt cop or malicious or incompetent doctor, but we can make reasonable and serious attempts to avoid foreseeable harms, just like we could for euthanasia laws. For example, we can require psychiatric assessment of patients who request euthanasia (to ensure the person is of sound mind and not just depressed); we can require that multiple, independent physicians agree on the diagnosis, prognosis, and current state and nature of suffering in the patient (to minimise physician-related errors or misjudgements); we can require that requests for euthanasia are repeated, sustained over time, and that only the patient herself is involved in these requests (to prevent unscrupulous friends or family influencing the patient); and so on. It is also worth pointing out that if any abuses have occurred, it is not automatically a strike against voluntary euthanasia laws generally but rather only one statute or perhaps its related institutions and legal or medical practices. Such abuses – again, if they have occurred – may have been preventable given a better policy.

As pragmatic asides, there are also some shared benefits for those left behind after someone dies by voluntary euthanasia. Two prominent benefits were illustrated in mock adverts created as part of the ABC’s television program ‘Gruen Planet’, which analysed advertising practices and trends. In one of the show’s segments, agencies compete to sell the unsellable, and were once asked to persuade Australians that we should make euthanasia compulsory for seniors by the age of 80.

“I never met my granny, because she lived very far away,” begins one advert with a little girl sitting alone, clutching a family photo. “I would have made more time somehow,” a man says about his mother passing away. It’s almost universally true that people put off seeing their relatives or parents. None of us normally intend to, it’s just that we get caught up in our day-to-day lives. When terminally ill patients go through years of treatment and their health very gradually declines, it can be just as easy for family members to miss their opportunity to spend significant time together. Giving these terminally ill patients the option of setting a definite time to die not only gives back some small sense of control in a situation they have had no control over, but it also gives them and their families specified time to spend wisely and meaningfully.

Where the first advert spoke to emotion, the second speaks to reason. “With resources stretched to the limit and the elderly living longer, the time is fast approaching when we have to make some tough decisions,” says an elderly gentleman as he leans out of his hospital bed. He walks down the hall to the maternity wing, looking into a room with a mother caring for her newborn. “Perhaps that time is now.”

While voluntary euthanasia should, in its primary focus, be about the patient, we cannot deny that there are some economic and emotional benefits for those left behind. Being aware of these benefits, including those which may motivate abuses, is vital to assessing any legislative proposal on this issue. Prescribing morals or crying wolf without even hearing a howl, however, is irresponsible, and causes women and men like Mr Strike to suffer unnecessarily long, painful deaths. Let’s not let our common dignity bear a similar fate.