Bioethics in Faith and Practice, Volume 3, Number 1

28 Swazo ⦁ Non-voluntary Euthanasia 28 The standard Kantian argument is that, as long as an individual is “still a rational, autonomous agent,” then “the volition of the patient must be respected, and he or she could not be forced into any action, much less death.” The same argument applies in the case of Mr. Hossain’s older son Abdus Saber—his DMD has not led to a diminished cognitive status or a sustained mental dullness that otherwise diminishes his capacity to judge his physical condition and to make informed decisions as to his personal care, in which case respect for Abdus Saber’s personhood and uncompromised moral agency prohibits any act of involuntary active euthanasia. The problem for Sharp, however, is that some writers go so far as to argue, “suicide would actually be morally required by rational beings who know that they will soon become irrational.” 30 One might structure an argument in present case consistent with the foregoing position, to the effect that: If the older son Abdus Saber is a rational being and, thus, a person having freedom of will with capacity to choose his ends and the means to those ends, then Abdus Saber is a moral agent. But, if (thus when ) he is no longer capable of choosing his ends, then Abdus Saber is no longer a moral agent. If (or when) Abdus Saber is no longer a moral agent, then Mr. Hossain, as parent and surrogate decision maker, may make moral decisions that concern Abdus Saber’s moral status and disposition (life or death). In present case, Mr. Hossain believes Abdus Saber should be euthanized (for the reasons already noted) and requested government permission to have this done. Respecting Mr. Hossain’s moral authority and preference here, the government should concur, deferring to Mr. Hossain’s rational autonomy as a responsible moral agent. Therefore, Abdus Saber should be euthanized. At issue in the above argument, however, is Abdus Saber’s moral agency: Anticipating loss of his moral agency due to prospective cognitive impairment (i.e., assuming this is an effect of sustained respiratory dysfunction and hypoxia), it is being argued that Abdus Saber himself has a duty to authorize his death in advance of his deteriorated physical condition due to DMD. But, of course, the government (a) need not defer to the judgment of the father (since his moral reasoning may be in error) and (b) because the government itself has a public welfare and public health responsibility that weighs into the decision to be taken and may weigh against a recommendation for non-voluntary active euthanasia in a case such as the present one; and, more importantly, the government may contest the premise that anticipated loss of moral agency entails the moral duty stipulated. As Sharp rightly notes, the appeal here is to what Kant has to say about suicide in his Lectures on Ethics , i.e., “suicide is wrong because it ‘contradicts the more basic principle to preserve the freedom of moral agents.’” 31 The point here is to act such that one is concerned to maintain “the inherent dignity and freedom of moral agents,” i.e., “in cases where maintaining life would require us to sacrifice our moral dignity or autonomy, we have a duty to die.” In extreme dementia—or, in present case, in the case of extreme hypoxia degenerating Abus Saber’s rational capacity “to the point of incompetence”—“those who suffer from the syndrome lose their rationality, autonomy, and humanity. They have a duty to die in order to avoid that fate.” 32 Yet, the Kantian argument as expressed by the law of humanity specifies that one may not treat oneself arbitrarily, i.e., merely as a means, to some particular end, thus the need to account for an individual’s “intrinsic” worth and dignity. The sort of argument presented above assumes “levels of selfhood” such as described by Daniel Callahan, “the highest of which is the moral self (fully rational, autonomous agent),” such that “this level is essential for human dignity and worth.” 33 However, Sharp counters the inference with the relevant question: “we must still ask why becoming a non-person [through the extreme dementia that entails loss of moral agency, autonomy, and thus human dignity; or, in present case of Abdus Saber, the loss of moral agency due to the cognitive impairment consequent to sustained hypoxia from DMD] is so terrible that