Abstract
Hull and McKeown O’Donovan offer a philosophical examination of the case of Marie Fleming, confined to a wheelchair and in the final stages of multiple sclerosis. The High Court in the Republic of Ireland ruled that she did not have the right to be assisted in taking her own life and made a strong moral distinction between letting nature take its course and bringing about death. Through an examination of the work of Jonathan Glover, Shelly Kagan, Warren Quinn, and James Rachels, the authors argue that the most compelling philosophical basis for a moral emphasis on the distinction between acts and omissions lies in the structural difference, where acts interfere with a victim in a way that omissions do not. It is also argued that assisted suicide can be morally justified in the advanced stages of terminal illness in a limited way that can resist any inevitable descent down a slippery slope.
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- 1.
Section 2(2) of the law states that: ‘A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offence and shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years’.
- 2.
Kearns (2013, section 3). The case was judged by a three-judge High Court, comprising the President of the High Court, Mr. Justice Nicholas Kearns, and Mr. Justice Paul Carney, and Mr. Justice Gerard Hogan.
- 3.
Kearns (2013, section 19). The Expanded Disability Status Scale (EDSS) is a method of quantifying disability in MS and monitoring changes in the disability over time. The scale was developed by a neurologist named John Kurtzke in 1983 and is widely used in clinical trials and in the assessment of people with MS. The EDSS ranges from 0 to 10 in 0.5 increments that represent higher levels of disability, and scoring is based on examination by a neurologist (see Kurtzke 1983).
- 4.
Rachels (1975, pp. 78–80) puts forward the analogy of Smith and Jones, two individuals who both have inheritance to gain in the event of the death of their 6-year-old cousin. Both individuals want the child dead. In the first instance, Smith acts and drowns the child in the bath. In the second instance, Jones sets out to kill the child, but happens upon the 6-year-old drowning in the bath of his own accord and stands by and watches—an omission of action with the same direct consequence as the action taken by Smith. While designed to make us worry a lot about some omissions, this example illustrates the structural difference explored by Kagan (1989) that we discuss later in the chapter.
- 5.
Kearns (2013, section 55). While other distinctions can combine with and contribute to the view expressed in the Court’s comment, like the distinction between intention and foresight and the distinction between passive and active treatment options, our sole focus here will be on the distinction between acts and omissions.
- 6.
See, for example, the case of Savita Halappanavar, where the point has been made that action in the form of a termination was seen as less morally defensible than omitting to act and waiting for the foetal heartbeat to stop—an event which was inevitable (Holland 2012). The reluctance to perform a termination was reported to have contributed to the death of Savita Halappanavar.
- 7.
For example, Rachels (1999, p. 230) contends that ‘[l]etting someone die … is a kind of action’.
- 8.
Quinn’s ‘Rescue III’ example, for instance, is a variation of the Trolley Problem, where we have the choice to stop a train or to let it continue on automatic control when one person is trapped ahead on the track. If we stop the train and free the trapped person, the rescue mission to save five others will be aborted (Quinn 1989, p. 298).
- 9.
- 10.
Development of this position in a practical sense would require agreement as to how close to the end of one’s life one might reasonably be expected to be.
- 11.
See, for example, the case of Daniel James (Booth 2008). As recorded in a 2014 Guardian article, there are other high profile cases, notably in Belgium, that would not be sanctioned by the reasoning here. These include a 44-year-old transsexual woman, ‘whose botched sex-change operation left her with physical deformities that she felt made her look like a “monster”; and 45-year-old identical twins who were deaf and going blind and believed they had nothing left to live for’ (Guardian Staff 2014). Of further interest to the analysis here, is that the article also notes that more recent legislation in Belgium legalizing euthanasia for children stipulates that minors must be terminally ill, close to death, and suffering beyond any medical help. Views about euthanasia and euthanasia for children aside, these legislative stipulations do reflect the arguments of the position developed here.
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Hull, R., O’Donovan, A.M. (2016). Acts, Omissions, and Assisted Death: Some Reflections on the Marie Fleming Case. In: Fives, A., Breen, K. (eds) Philosophy and Political Engagement. International Political Theory. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-44587-2_5
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