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Commentaries
On ‘What makes killing wrong?’
  1. Julia Driver
  1. Correspondence to Professor Julia Driver, Department of Philosophy, Washington University in St. Louis, Box 1073, One Brookings Dr., St. Louis, MO 63130, USA; jdriver{at}artsci.wustl.edu

https://doi.org/10.1136/medethics-2012-100651

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    Walter Sinnott-Armstrong and Franklin Miller1 make a convincing case for their claim that what is wrong about killing someone is that one is putting the person in a state of universal and irreversible disability. Thus, killing in and of itself is not an additional harm for a person who has been universally and irreversibly disabled. The implications for such a view are, as they note, quite wide-ranging. Given advances in medical technology, there are individuals being kept alive now who are universally and irreversibly disabled. Not only would death not be viewed as an additional harm, but it may also be the case that the organs of such individuals should be made available to save the lives of those who are not universally and irreversibly disabled. Given how Sinnott-Armstrong and Miller spell out what universal and irreversible mean, I am in broad agreement (with a caveat to be discussed below). On their view, the universal disability involves total loss of sentience, autonomy and rationality, as illustrated by the case of Betty who is alive, but lacking all capacity for pleasure, pain, control and so forth. However, I do think it is worth noting additional advantages as well as possible disadvantages to their approach.

    Legal implications

    One legal implication would be a pro tanto reason to treat universal and irreversible disability as a form of murder. A person who lingers in such a state for over a year in many locations is not considered a murder victim, and murder is typically treated more harshly than assault. Sinnott-Armstrong and Miller have provided some rationale for changing that perspective. However, there are some questions regarding how to understand this, depending upon how we cash out ‘irreversible’. Is ‘irreversible’ relational? So, for example, some people who are irreversibly comatose today may—if they were alive in some other future century rather than the present one—be in a reversible coma if medical technology progresses in ways helpful to treating certain brain injuries. Suppose that Sinnott-Armstrong and Miller are using ‘irreversible’ relationally. Imagine that I am a physician in charge of a ward of 1000 patients who are universally disabled, but not irreversibly so in that there does exist a medicine that will reverse the condition. However, there is only one dose of this medicine. Should I give it to one patient, thereby saving her? If I do that then I have, de facto, killed the other 999 patients. On the other hand, if I don't then I haven't killed anyone, since there is still a way in which each can have his or her condition reversed. This is puzzling.

    The ‘indirect duties’ objection

    Immanuel Kant famously argued that some of the duties that we have are ‘indirect’.i For example, we have duties to non-rational animals not because we owe the animals themselves anything, but because harming animals corrupts our relationships with other rational beings. Thus, our duties to animals are indirect. The explanation is psychological. Animals resemble human beings sufficiently that mistreating them will undermine our virtuous dispositions. One could argue similarly for universally and irreversibly disabled individuals—there are indirect duties in virtue of the fact that a breathing human being—though lacking sentience, autonomy and rationality—resembles the fully rational and autonomous human being sufficiently to warrant the same respectful treatment. Whether this is the case is an empirical issue, or course, but poses a potential difficulty for Sinnott-Armstrong and Miller.

    Desire-satisfaction model of harm

    Even if one believes that Betty is not capable any longer of forming her own desires, assuming that she was, at one point, a being that did possess desires, one or a cluster of those desires may have involved desires that her body not be treated a certain way. This is one way in which people analyse the harm involved in acts of necrophilia. In this way, Betty may still be harmed, though in a state of universal and irreversible disability.

    Reference

    1. ↵
      1. Sinnott-Armstrong W,
      2. Miller FG
      . What makes killing wrong? J Med Ethics 2012;39:3–7.

    Footnotes

    • Competing interests None.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • ↵i Lectures on Ethics, translated by Louis Infield (Indianapolis, Indiana, USA: Hackett Publishing Co., 1963): ‘Our duties towards animals are merely indirect duties towards humanity. Animal nature has analogies to human nature, and by doing our duties to animals in respect of manifestations which correspond to manifestations of human nature, we indirectly do our duty towards humanity.’ (p. 239)

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