Case C
This case was originally reported in Time, September 18, 1989 and is summarized as follows in "Problem Cases to Accompany Contemporary Moral Problems", ed. James E. White (New York: West Publishing, 1994) p. 14
"Larry McAfee was paralyzed from the neck down in a 1985 motorcycle accident; be he was still able to speak to others. To help him breathe, he was connected to a ventilator. After four years at the Briarcliffe Nursing Center in Alabaster, Alabama, he decided he did not want o live any longer, and he devised a plan to end his life. First he would be administered a sedative, and then he would shut off the ventilator himself by activating a timer with a mouth-held stick; after a length of time for the sedative to take effect, the timer would then shut off the ventilator.
He petitioned an Alabama court to be allowed to carry out his plan, and Fulton County Superior Court Judge Edward Johnson granted his petition, ruling that McAfee's right to refuse life-sustaining treatment outweighed the state's interest in preserving life. "The ventilator to which he is attached is not prolonging his life; it is prolonging his death," said Johnson."
Let us assume, for the purposes of this case, that McAfee was not depressed and that his request to be allowed to end his own life was both stable--he never wavered in his request to end his own life and he never displayed any ambivalence--and enduring--his request to end his own life was constant over time.
Is it morally permissible for McAfee to end his life as outlined above?
Theory Applied: Social Contract Theory (SCT)
Conclusion: It is morally permissible for Larry McAfee (LM) to end his life in the manner outlined in the case.
According to SCT, an action x is morally permissible if x is consistent with a rule necessary for social living, where a rule is necessary for social living just in case perfectly rational agents would agree to act according to the rule for their mutual benefit, provided everyone act according to the rule.
Consider the following rule R:
R: Competent adults should be allowed to do as they please, provided their actions do no foreseeable harm to others.
R is, of course, a principle of autonomy with something like the harm principle built in as an exception. I claim that this rule is necessary for social living. That is to say, I claim that perfectly rational agents would agree to act according to this rule for their mutual benefit, provided everyone acted according to the rule.
It is, of course, difficult to know just what perfectly rational agents would agree to. Accordingly, I will present two arguments that R is necessary for social living. In the first I will argue that ideally or perfectly rational agents would indeed consent to act in accordance with R for their mutual benefit, provided everyone do so. In the second argument, I will consider what one's informed preference--informed, that is, by knowing what is in one's own best interests--would be if one were put behind a relevant veil of ignorance.
Argument I:
First, consider the following argument, Argument IA:
1. If X is a competent adult, then X generally better knows what is in X's best interests than anyone else.
--Premise 1 follows virtually by definition: what it means to be a competent adult is, among other things at least, to be the best--though certainly not infallible--judge of what is in one's own best interests.
2. If X generally better knows what is in X's best interests than anyone else, then X is generally better off if X acts autonomously than not.
--Premise 2 follows from the fact that if X acts autonomously X's actions are self-directed instead of other-directed--trivially, of course, since this merely follows from the definition of autonomous. More to the point is that if X is a better judge of what is in X's best interests than others, then X's self-directed activities are generally better for X--allowing, naturally, for X's fallibility--than other-directed activities.
3. If X is generally better off if X acts autonomously than not, then X should be allowed to do as X pleases provided X's actions do no foreseeable harm to others.
--Premise 3 follows if one places X in a social context: Given that X is generally better off if X acts autonomously than not, X should be given as much free rein as possible. The limit of X's autonomy is, clearly, the extent to which X's subsequent self-directed actions might harm others with what X can be expected to anticipate about possible harm to others from X's actions. Such a restriction on X's autonomy is likewise in X's best interests since, in a social context, others are similarly restricted and thus may not harm X.
Therefore,
4. If X is a competent adult, then X should be allowed to do as X pleases provided X's actions do no foreseeable harm to others.
Argument IA is clearly valid. Moreover, each of the premises is straightforwardly true as shown in each case. Thus the argument is sound. So it follows that the conclusion is true. Since the argument is sound any perfectly rational agent would be driven to acknowledge the truth of the conclusion of Argument IA just as we have been so driven. Put it this way: No perfectly rational self-interested agent in a social context could object to any of the premisses of Argument IA. Accordingly, perfectly rational self-interested agents in a social context would have to admit that the conclusion is true, since, of course, IA is valid. But since every perfectly rational agent is a competent adult, it follows that rational agents would agree to act in accord with the rule that they be allowed to do as they please provided they do no foreseeable harm to others for their mutual benefit, provided, of course, that everyone so act. But since every perfectly rational agent must accept Argument IA as sound, and since every perfectly rational agent is a competent adult, it follows that everyone would act in accord with the rule R. Hence R is necessary for social living.
Argument II:
This argument is much simpler. Consider a social situation in which one person, person A, is free to do as he/she pleases provided he/she does no foreseeable harm to others. In the same social situation consider another person, Person B, who is not free to do as he/she pleases. B's actions are other-directed, not self-directed like A's. Unlike A, B is told what to do and when to do it. B has no option except to act as he/she is told. B's life is very much like that of a young child's: B is not trusted to know what is in his/her best interests, so B is told to act according to what someone else thinks is in his/her best interests. A, on the other hand, is never told what to do and does pretty much as he/she pleases, except when A's actions could foreseeably harm someone else. Thus A is not, for example, allowed to drive intoxicated. Nor is A allowed to drive as fast as he/she wants. There are limits on what A can do, but those limits are all only associated with what could foreseeably harm others. A is something like an adult in our society, but there are significant differences. For instance, in our society no adult can use drugs other than caffeine, nicotine, or alcohol. But A is allowed to use any drugs A sees fit, except perhaps for drugs which would result in uncontrollable aggressive behavior on A's part (since, of course, in that case A's action of taking the drug would foreseeably harm others. Fortunately there aren't many such drugs. Actually there may not be any such drugs.)
Now I invite the reader to put him/herself behind the veil of ignorance. The reader does not know which social role he or she will fill: A's or B's? Which role would the reader prefer--where presumably the reader's preference is informed by knowing what is in his or her best interests--A's or B's? It is not presumptuous for me to assert, based on my own so-informed preferences, that the reader will agree that it would be far better to fill A's role than B's role; assuming, obviously, that the reader's preference is informed by an awareness of what is actually in his or her best interests. I cannot be responsible for a reader who actually thinks living a life of a young child with virtually every of one's actions other-directed is better than the alternative. Such a reader, I must conclude, does not really know what is in his or her best interests and so could not be considered a competent adult in the first place. Rule R, then, is necessary for social living since the choice of who's role--A's or B's--one should fill is so obvious--A's, to be perfectly clear--and R is consistent with A's role but not B's.
I have given two arguments for the conclusion that R is necessary for social living. Based on the soundness of these arguments, it follows that R is indeed necessary for social living. Let us now turn to LM's problem.
The problem in LM's case is to determine whether or not his action of allowing himself to die by turning off his respirator is morally permissible. There are two questions which must be answered to see if this action is consistent with R.
First, is LM a competent adult?
According to the case description, we may assume that LM was not depressed and that his request to be allowed to end his own life was both stable--he never wavered in his request to end his own life and he never displayed any ambivalence--and enduring--his request to end his own life was constant over time. Moreover, LM has lived on a respirator for four years. He certainly has given such a lifestyle a reasonable chance, as he might not have had he made the request to be allowed to turn off the respirator after, say, two weeks. LM is thus fully informed and is, indeed, a competent adult.
Second, does LM's action do any foreseeable harm to others?
It might be argued, I can imagine, that LM's action might harm his loved-ones. After all, he will be dead and so will be unable to contribute to their lives as he otherwise would have. On the other hand, it could not reasonably be maintained that, living in a nursing home, he is contributing much to their lives as it is. More importantly, any loved-one worthy of the name would have to grant to LM is not living a life that is, shall we say, worth living. That's perhaps not the best way to put the point. A better way is this: A loved-one would, by definition, want what is best for LM. But LM, as a competent adult who therefore knows better what is in his best interests, has decided to end his life. Thus, while there might be some foreseeable emotional harm to his loved-ones at his loss, this harm is surely offset by the good the comes from knowing that LM has done what is best for himself.
LM's action of turning off his respirator is, therefore, consistent with rule R. But by SCT it follows that LM's action is morally permissible, since R is, as has been shown, necessary for social living.