Bioethics in Faith and Practice, Volume 3, Number 1

Bioethics in Faith and Practice ⦁ 2017 ⦁ Volume 3 ⦁ Number 1 27 case of the younger son and grandson [both not of age of maturity and subject to the proxy consent of the parent(s)]. B. A Kantian Concern for Non-voluntary Active Euthanasia The Bangladesh case raises the question of the morality of both involuntary active euthanasia and non- voluntary active euthanasia, accounting here for the particulars of DMD and the father’s burden and distress about the suffering of his two sons and grandson. One may consider reasoning analogically in view of concerns about non-voluntary active euthanasia in the case of patients suffering extreme dementia, and do so with reference to Kant’s deontology. Obviously, the comparison to extreme dementia has its difficulties for a fully successful analogy, given available empirical evidence as to what a patient experiencing dementia understands and knows, including here self-awareness and competence to opine on his/her condition. As is well known, Kant argued against suicide. 27 Kant’s argument concerns an individual’s necessary duties to oneself. He considers that someone may identify what is prima facie a subjectively valid maxim and think this maxim morally authoritative so as to warrant an act of suicide. Such a maxim might be formulated thus: “To escape from painful circumstances, I will destroy myself (i.e., commit suicide).” The question, of course, is whether this maxim may be construed objectively valid, thus as a universal practical law consistent with one’s duties to humanity. Kant’s analysis concerns the logical coherence of the maxim with the idea of humanity, all humans as rational beings obligating our respect for personhood insofar as persons have intrinsic worth and, thus, dignity. Logical coherence requires that one avoid a contradiction in the conception of the maxim. Kant is also concerned to assure that an individual distinguish between acting according to inclination (i.e., a motive of need or desire) and acting from duty (i.e., a motive of respect for moral law). Thus, Kant’s argument is grounded on the distinction of persons and things, such that an individual may not use a person (in contrast to a thing) “merely as a means to maintain a tolerable condition up to the end of life.” The latter is motivated by inclination, not duty. Kant concludes, “I cannot, therefore, dispose in any way of a man in my own person so as to mutilate him, to damage or kill him.” The intended maxim, in short, is not objectively valid and is not the equivalent of a universal moral law. Suicide is, therefore, for all persons morally prohibited. The assumption is that this conclusion holds for active euthanasia, although the argument is to be provided. Consider Robert Sharp’s account of developments in moral assessment according to which, “some writers have claimed that the onset of dementia may circumvent the usual Kantian response, since dementia undermines our ability to be moral agents. ” 28 At issue here is an individual’s capacity for moral agency, the absence of which may alter one’s otherwise Kantian commitment to prohibit suicide and, by extension, assisted dying. This relates to the present case only in the sense that, as with dementia, DMD patients experience a progressive degeneration of cognitive ability which may, under some reasoning, undermine that individual’s ability to be (and thus to be considered) a moral agent. Nonetheless, Sharp’s concern is primarily one of slippery slope: “I worry that [some proponents, who “have argued that suicide would actually be morally required by rational beings who know that they will soon become irrational”] open the door to much more unsettling (at least to me) possibilities, including (but not limited to) the obligation to commit active, non-voluntary euthanasia against those patients who refuse to commit suicide.” 29 The problem with respect to our present case is that someone might similarly argue that one suffering from DMD understands s/he will become irrational and thus has an obligation to enable active non-voluntary euthanasia—however repugnant such an argument may be.