I read with appreciation Alex Hibbs’ gracious review of my book on the ethics of physician-assisted death and euthanasia, How Should We Then Die? He raised an important worry about the central argument of the book concerning human value, that the logical consequences entailed by the very high conception of human value on offer renders that conception untenable. In other words, the argument appears to prove too much. For example, does drawing a logical line from the fact of intrinsic human value (which he fully endorses) to the intrinsic goodness of human existence (and hence the inviolability of life and the wrongness of killing) entail opposition to all forms of killing, including those that Christians have traditionally viewed as morally acceptable such as war, capital punishment, and self-defence? Does affirming the intrinsic goodness of human existence commit one to pacifism and quietism in the face of evil? He suggests that the conception of human value outlined in the book fails to consider the “hierarchy of goods necessary to combat wickedness.”
These are weighty concerns. If my argument against euthanasia from intrinsic human value proves too much and forces us to reject actions which we are convinced are licit, then it cannot serve as a coherent or effective basis for opposing euthanasia. I believe, however, that the argument can withstand such scrutiny when additional foundational moral concepts are brought to bear on this issue (concepts that were slightly out of scope for a short book on euthanasia).
First, let me clarify what I mean in asserting that intrinsic human value entails intrinsic goodness of human existence. To say that value and goodness of existence are coupled is to say that valuing something and valuing its existence are the same thing. Therefore, you cannot express the value of something by ending its existence. Insofar as love is fundamentally the affirmation that “it is good that you exist”,[1] then killing is never an act of love toward the person killed. Furthermore, to say that someone has intrinsic value is to say that it is intrinsically good that they exist; their existence cannot lose its value. Therefore, if killing can be justified, it cannot be on the grounds that the person’s existence has lost its value.
The crucial point here with respect to euthanasia is that euthanasia proponents claim that “mercy killing” is an act of love, an expression of value and respect for the person. But if valuing someone entails valuing their existence, then the notion that euthanasia respects human value is absurd. Moreover, it was important to recognize that requests for euthanasia are motivated by the temptation to forget the value of one’s existence in the midst of deep suffering. In refusing to end the patient, we remind them that it is impossible for their existence to lose its value. Their life always matters.
The crucial question then is whether there are conditions under which one can affirm that it is intrinsically good that a person exists even while undertaking actions that either intentionally or unintentionally bring about the end of their existence. To establish such conditions, we must reflect on the nature of human moral agency. Moral agency is a crowning feature of our status as Divine image bearers. Godlike, we exercise human rationality to discern the good and intentionally seek the good. Intention here refers to the capacity to form aims and goals and projects. Intention is fundamental to moral agency because it reflects our will and hence our moral character. To aim at evil is to be evil. Thus we draw a crucial moral distinction between consequences that are intended by our actions and those that are merely foreseen (a carefully developed version of this distinction is referred to as the doctrine of double effect).[2] Moral agency entails moral responsibility—our intentions render our actions and our persons susceptible to moral judgment. As rational moral agents facing the reality of evil in a fallen world, we are expected to render judgment in accordance with justice, to respond to evil in due proportion and in a due manner. Consequently, both the good and the right have a claim upon our actions. In a fallen world—East of Eden—actions required by the right may sometimes seem to conflict with the good. This conflict reflects the tragic character of the human condition in this present evil age.
With these additional moral concepts in view—agency, intention, foresight, culpability, judgment, justice, and the potential conflict between the good and the right—we may proceed to ask whether there might be conditions under which one can consistently affirm the intrinsic goodness of human existence while acting in a manner that brings about death.
First, causing death can be justified when the intention of the action was to preserve life, and death is a foreseen but unintended and unavoidable consequence. Consider the actions of the police officers who took the life of Audrey Hale, known as the Covenant School, Nashville shooter (to respond to the tragic example offered by Hibbs). As moral agents, the officers’ primary intentions were to preserve human life in recognition of human value. To fulfill those intentions, they acted to incapacitate the shooter, almost certainly foreseeing that such actions could cause the death of the shooter. The value of human life therefore serves as the moral justification for their actions, and given the distinction between intending and foreseeing, their actions did not fail to accord with that value.[3] Such actions are therefore entirely in keeping with my thesis about the intrinsic goodness of human existence.
Even so, the shooter was a fellow human creature, possessed of intrinsic human value. Her death was a tragedy, even if her moral agency rendered her entirely culpable for the deaths of others possessed of the same intrinsic value. It was right that the shooter died, but it was not a good to be celebrated. A similar framework delineates the conditions for a just war.[4]
In the case of capital punishment, the express intention of the action is to cause the death of the person who has been found guilty. Therefore, we can make no appeal to the distinction between intending and foreseeing to legitimize the act.
Nevertheless, as moral agents we are obligated to respond to the demands of justice. By his evil actions reflecting evil intentions, the murderer has rendered himself culpable for the death of another. An innocent person of intrinsic value, priceless and irreplaceable, has been taken from us by that act of murder, and justice cries out for a due response. The punishment must fit the crime. Therefore, in light of the depth of human value, capital punishment is the only just sentence, and the demands of justice require the life of the offender. To refuse to proceed with capital punishment is to deny the true depth of value of the innocent victim. Still, the death of the offender, however just, comes to us as a tragedy—for he was made in God’s image.
Note that this is the exact reasoning employed in the Noahic covenant (Genesis 9), one of the clearest statements of human value in Scripture: “Whoever sheds the blood of man, by man shall his blood be shed, for God made man in his own image.” The severity of the punishment reflects the true magnitude of the crime. And the magnitude of the crime derives from the profound value of the human person, a value that demands a sacred regard for their existence.
In light of these considerations, I remain persuaded that the central argument of my book against euthanasia—that it contravenes the intrinsic goodness of human existence logically entailed by the fact of intrinsic human value—holds up to the important scrutiny offered by Hibbs. East of Eden, the truth that it is “always good that we exist” does not mean that it is “always right that we exist.” Indeed, the sentence of death hangs over us all, for we have all participated in cosmic treason against the One in whom we live and move and have our being. Only in the long-awaited eschaton will the good and the right concerning humanity be fully reconciled. Given the range of threats to human value and human life in this present evil age, whether from euthanasia or from more overt forms of violence, I admit that clarifications are required to frame the argument with due precision, and I am grateful for the opportunity to offer such clarifications.
Ewan Goligher (MD, University of British Columbia; PhD, University of Toronto) is associate professor of medicine and physiology at the University of Toronto and has published over 100 papers and several book chapters. As a physician practicing critical care medicine, he is regularly involved in helping patients and families navigate difficult decisions about medical care at the end of life. His book How Should We Then Die? is available from Lexham Press.
Joseph Pieper, Faith, Hope, Love (Ignatius Press, 1997), 164. ↑
Gilbert Meilaender offers an insightful discussion of the intending/foreseeing distinction in “Comforting when we cannot heal: the ethics of palliative sedation.” Theoretical Medicine and Bioethics 2018; 39:211–220. ↑
Interested readers may wish to consult Thomas Aquinas, Summa Theologiae, II-II, Q. 64, Article 7, for an articulate defense of this reasoning. ↑
Again, Aquinas, drawing on Augustine, gives a classic summary of Christian thought on this matter. ST, II-II, q. 40, a. 1. ↑