A Duty to Die?
By Victor Morawski
About twenty-five years ago, then-Colorado Governor Richard D. Lamm stirred up a bee's nest of controversy with his assertion that elderly, terminally ill patients have “got a duty to die and get out of the way.” While the Governor has since waffled on whether he actually meant the words he actually said, plenty of others have not on this issue. A good example of this, and perhaps a good gauge of where the debate in this country is headed as we come closer to the reality of a one-payer system for health care is the claim by British Baroness Warnock that dementia patients “should consider ending their lives because they are a burden on the NHS [National Health Service] and their families.”
How does one get to the point of saying that some members of society have an actual duty to die? What moral reasoning lies in back of such a stance? While it is possible to produce a full-blown Marxist-Socialist argument in support of such a position—for example that these people cannot actively support and indeed may actually hinder Marxist Revolutionary progress, hence they have a duty to get out of the way—in Western Society, arguments underpinning a “duty to die” have usually arisen instead from the moral theory of Utilitarianism. Not itself a Socialist Ethic, it more often than not comes down with the same moral prescriptions as Socialism because like it, Utilitarianism emphasizes the supposed general good of society over the interests of the individual.
Invented in the nineteenth century by philosopher Jeremy Bentham as a means to provide moral support for reforms to the British legal system, Utilitarianism has become one of the dominant systems of secular ethics. Its deceptive simplicity has lured many into its camp for, under this view, we as human beings have only one all-encompassing moral duty: to act so as to promote the greatest good (as far as the consequences of our actions are concerned) for the greatest number of people (be it those immediately affected by what we do or society as a whole).
Its founder Bentham originally understood as ‘good' that which increases the overall balance of happiness in society or at least lessens unhappiness. Optimistically, Bentham initially thought that we could work out our moral duty with near mathematical precision by comparing the consequences of two possible courses of action in terms of their production of overall societal happiness. Unrealistically, he thought we could talk about it in measurable units. This turned out to be a non-starter because we cannot know whether we have two or ten of something until we know what counts as having one of that thing. And how can we say with any precision what is to count as one unit of happiness?
Enter the Cost-Benefit Analysis. While we may not be able to specify with any precision what counts as a unit of happiness, we do know what counts as one dollar. Because of the impracticality of talking about moral right and wrong in terms of the promotion of human happiness, a number of modern utilitarians have tied together their theory with the business practice of developing a cost-benefit analysis. Here the morally right course of action then becomes what on balance produces the greatest benefits for the costs involved. This marriage of an essentially value-neutral accounting practice with utilitarian moral theory produces a deadly combination. For now, in the realm of health care spending, it is not just financially prudent—a matter of good business sense—to make decisions in terms of what produces the most benefits for the costs involved, it is our moral duty to do so!
The costs of treating elderly patients whose prognosis is poor and who have much less to give back to society than those much younger, even if their course of treatment is successful, result in insufficient benefits to justify them for the utilitarian. In a health care system governed by the free market, individuals may nonetheless choose to incur these costs of treatment because they are spending their own money either directly or for insurance premiums to their private insurer. But in a single-payer system, the costs of health care for individuals are the costs of it to society. If in it officials deciding on the allocation of care see it as their moral obligation to do so in a way that produces the most benefits for society for the costs involved, then elderly patients whose treatment will likely produce far fewer benefits will invariably lose out and be denied care. But moralists like Baroness Warnock argue that they should accept this consequence as their moral duty to society as it reduces society's costs and the emotional burden on their families. It is, she argues, their moral duty to die!
At this point, some readers may want to ask, “But isn't human life itself an unqualified good, to be preserved no matter what the costs? Does not this patient have an inalienable right to life that alone would justify his or her treatment?” What would a utilitarian say of an appeal to this right? For utilitarians, rights are derivative on duties, any rights we have are derived from duties others have toward us and these duties are determined by what produces the greatest good for the greatest number of persons. If it does so to provide members of society with universal health care, as some utilitarians would claim, then society has a duty to do so. As a result, individuals have a right to expect this provision from society. Utilitarianism can thus support this supposed positive right to universal health care. Conversely, however, we have no rights that are not derived from our sole obligation to promote society's greater good and, what is more important, can have no rights that would conflict with this obligation. So, if providing care to an elderly, terminally ill patient conflicts with this obligation then that patient has no right to expect such care. Thus, utilitarianism is destructive of rights like the right to life—as will be government-administered universal health care.
Victor Morawski teaches philosophy at Coppin State University. His column, "The Philosopher's Stone," is distributed nationally free of charge by the Liberty Features Syndicate. Should you wish to subscribe, contact Alex Rosenwald at email@example.com.