Thursday, May 07, 2009

Intention in Cardiff

I recently gave a talk on euthanasia to the studen Pro-Life Society in Cardiff University. This gave rise to a question from a graduate student, by email, as follows (in part). His questions are in blue, my replies in bold.

I agree that intent is vitally important but I think it only applies more broadly than to killing/not killing. With the example of the child slipping in the bath. Would it have not been wrong if the intent was primarily to gain the inheritance, with an undesirable side effect being the child dying? I think yes! You phrased this scenario as wanting to let the child drown so that you could claim the inheritance. But is there a difference between the two as I have worded them?

The point of the example is that the person looking after the child needs the child to die if he is to inherit the money. The death of the child is intended, therefore, as a means to inheriting. We intend means in exactly the same way as we intend ends.

You also gave the example of not jumping into the river to save your rival, because it would spoil your shoes. This was okay despite knowing that not jumping would cause his death because his death was not your primary intent even though it might be your desire. But on the other hand not jumping in because you desired his death was wrong.

I fail to see the difference. In both cases you have knowingly chosen not to act to save his life. The intension does not justify the end. If saving his life was right, then you have done wrong. Either you have valued shoes which are not sacred above a life which is. Or you have wished a man to die for your own benefit.

The 'end', saving ones shoes, does not really need to be justified: it is not wrong. I didn't say that it would be permissible not to jump in, out of concern for one's shoes, only that it would be possible. It would be wrong because it would infringe one's obligation of aid to someone in danger of death. It would not be wrong becuase the bystander intended the death - ex hypothesi he didn't.

If I intend to buy a cheap pair of shoes and as a result of that demand a child is forced to attempt to supply my 'need' in a sweatshop and as a result of industrial accidents/poor conditions dies am I then responsible?... given that I already know that children are dying in sweatshops.

I was not intending death but I still think the knowledge of the means makes me somewhat culpable. (I bought a £10 pair of shoes yesterday, and am feeling a bit guilty)

You may be complicit in a bad situation: in technical language, you might be involved in material cooperation with evil. But you don't intend the evil, which makes it less bad. Obviously it is worse if you are buying the shoes in order that the child dies.

So, can I turn off a machine, for the patients 'good', be that the prevention of suffering or etc. when I know this bring about immediate death? I can only be innocent if somehow I believe that their death will not be, 'bad'. Indeed that allowing the inevitable to hasten nearer is somehow 'good' and in their best interest, on balance, given the discomfort of being in a coma, having a feed tube in place, etc. If their death can then be described as good how can it be wrong to desire it for a patient. If it is not wrong to desire it. Why should it be wrong to act in the patients 'good' or best interest to allow it to happen. Not to make it happen but allow it to happen.

Another way of putting this is: the doctor stops the treatment when the treatment is no longer doing the patient any real good. I agree.

I think there is a clear difference between injecting potassium, which is fatal (and largely untraceable) and not giving antibiotics/more chemotherapy/IV food&fluids. In the first, you are taking the ending of a person's life into your own hands. In the second you are deciding not to artificially prolong their life.

In medicine we artificially prolong life all the time. This is not wrong, in many causes it is good. This is good but I don't think it is always good or an obligation.

I had not heard that the intent to allow a person to die being described as wrong before. I ... struggle to see how intent to kill and intent to allow to die can be the same thing.

..But I really struggle to see the deference between intent and the expected side effects and how one can then be said to be morally responsible for one and not the other.

Well, how do you express the difference? This has proved, in the philosophical literature, to be extremely hard. If it is ok to 'permit' death (while intending it) and wrong to 'kill' (while intending), it will be easy to find ways to bring about people's death by omission, and not by action. The morally important difference, as is recognised by the law, is what you intended. If you intended the injection to kill, you have murdered the victim. If you intended to cure, or ease pain, then the death was either an accident or a side effect.

You are responsible for forseen side effects, however, under the principle of proportionality.

...With end of life events I really struggle to see more than a semantic difference between the intent to prevent suffering, by stopping feeding which will cause death, and intending to allow death, by stopping feeding which will cause an end to suffering. The outcome and ultimate intention is the same. In both I am aware of the consequences of my actions and have to believe that the intent, to prevent unnecessary suffering, allow God to make decisions as to when the life will actually end and respect the life that is there by not actively killing them will be enough.

I'm not sure what distinction you are trying to draw here. It is wrong to intend death, by action or omission. It is permissible to act or omit to act with the intention of easing pain; if this shortens life that it will be permissible if that is a proportionate evil to the good you are trying to bring about. In other words if the patient is going to die soon anyway, and the suffering is very great, and the only drugs which will ease the pain will shorten the life, you can intend the easing of pain knowing that your actions will shorten the life. This is no more 'murder' than building a road on which you know people will die - despite the fact that in these cases we are talking about actions, not omissions.