General Principles Concerning Suicide and Homicide
A Discussion of euthanasia through the use of narcotics in cases of incurable diseases periodically recurs, and the opinions of those in favor of putting the patient out of his misery are expressions of mere sentimentality, as in Maeterlinck's essay, Our Eternity. They think either that the passing of a law by a legislature removes all moral difficulty, or that morality is a trifle which should never stand in the way of expediency. Those who oppose this method of euthanasia base their argument, first, on the fact that many patients supposed by even clever diagnosticians to be incurable recover health; and, secondly, on the fact that the giving power of life and death to physicians is liable to grave abuse. This side misses the central truth and argues from accidental and secondary premises. Whether it is expedient, humane, or impolitic to kill incurable patients are almost irrelevant considerations: the fundamental question to be answered here is, Is there a Supreme Being who alone is master of life, to give it or to take it?
By its very definition such a Being is necessary (as opposed to contingent), self-existent; its essence always has been and always will be actualized into existence, and that from itself alone; it is an individual substance of an intelligent nature, and therefore a person. A contingent being is one that happens to be (contingere); it is of necessity neither existent nor non-existent; it has no logical aversion to existence, but in itself it has no more than a possibility of actuality. A necessary Being, on the contrary, essentially must be; it cannot not be; it is absolutely and essentially its own existence.
There must be such a Necessary Being. If there were not, all things would be contingent, which is an absurdity. The absurdity arises from the fact that if all things were contingent nothing would be actual, nothing could ever come into existence, because there would be nothing to bring the primitive potentiality of the contingent beings into actual existence. The sufficient reason for the existence of contingent beings is either in themselves or in something outside themselves. It cannot be in themselves, because as they do not yet exist they are nothing; therefore it is in a Being which is not contingent, but whatever is not contingent is necessary. Therefore the existence of contingent beings absolutely requires the existence of a Necessary Being, which always was in existence. The ordinary name for this Necessary Being is God. Contingent beings are all creatures, all organic and inorganic beings without exception. There is, then, a God, the first cause or creator of all contingent beings, among whom is man; and since God created man wholly, this creature is wholly subservient to God, under the dominion of God, and his life is owned solely by God; God alone is the master of life and death, and he alone can delegate such mastery.
From the relation between the Creator and the creatures arises the natural law. Violation of this law is the source of all moral evil in the world, and of much of the physical evil. Reason shows us this law, and the method of observing it; and reason and unreason, observance or disregard, of the order fixed by the natural law are the foundation of happiness and unhappiness. Whatever a human being is or does, he must seek happiness; that is an essential quality of his being. Happiness is the satisfying of our desires; but as our desires are limitless, only infinite good can satisfy them. The sole sufficient good that sates all human longing is the infinite Necessary Being, and to be happy we must be united with that Being. Obviously the only possible method of possessing this infinite God is through mental union, by undisturbable contemplation of his infinite truth, goodness, being, beauty, and his other attributes. If perfect, everlasting happiness is not in that, in what can it be? Is it in human fame, honor, riches, science, art, man, woman, or child? None of these can give lasting happiness, and no other happiness is real happiness.
Now, the only means we have to obtain union with infinite good is to follow out the condition inexorably placed by God, which is to act in life in keeping with right reason, to obey the law. Man's supreme honor is in freedom from the tyranny of unreason, and in a full obedience to external and immovable order, with the belief that his chief duty is to apprehend and to conform thereto.
This is morality. From the beginning men have held that certain acts are wrong and to be avoided, and that others are to be done. What is wrong, moreover, is such of its own nature, not from our will: we deem the fulfillment of duty, obedience to law, the first, highest, and last necessity of life. If we deny this truth we let in chaos. What is right or wrong is one or the other on its own merits, prescinding from its pleasurableness or pain.
We must seek good whether we will or not. Good is the sole object upon which the will operates, it is the raw material of the will's business. The ultimate standard of this good is God himself as its exemplary cause, but proximately the standard of moral good is our rational nature. Through our reason we judge whether a thing is good or bad; that is, whether it perfects or injures us; and as it is good or bad for us our will's tendency toward it is good or bad. Many acts are indifferent in themselves, but take on a good or bad quality from our intention; others are good or bad in themselves apart from our volition: charity is good, lying is bad, whether they are willed by us or not.
The morality of any action is determined (1) by the object of the action; (2) by the circumstances that accompany the action; (3) by the end the agent had in view.
1. The term object has various meanings, but here it means the deed performed in the action, the thing which the will chooses. That deed by its very nature may be good, or it may be bad, or it may be indifferent morally. To help the afflicted is in itself a good action, to blaspheme is a bad action, to walk is an indifferent action. Some bad actions are absolutely bad; they never can become good or indifferent—blasphemy or adultery, for example; others, as stealing, are evil because of a lack of right in the agent: these may become indifferent or good by acquiring the missing right. Others are evil because of the danger necessarily connected with their performance,—the danger of sin connected with them, or the unnecessary peril to life. An action, to have a moral quality, must be voluntary, deliberate; and mere repugnance in doing an act does not in itself make the act involuntary.
2. Circumstances sometimes, though not always, may add a new element of good or evil to an action. The circumstances of an action are the Agent, the Object, the Place in which the action is done, the Means used, the End in view, the Method observed in using the means, and the Time in which the deed is done. If a judge in his official capacity tells a sheriff to hang a criminal, and a private citizen gives the same command, the actions are very different morally because of the circumstance of the agent giving the command. The object—it changes the morality of the deed whether one steals a cent or a thousand dollars. The place—what might be an offensive action in a residence might be a sacrilege in a church. The means—to support a family by labor or thievery. The end in view—to give alms in obedience to divine command or to give them to buy votes. The method used in employing the means—kindly, say, or cruelly. The time—to do manual labor on Sunday or on Monday. Some circumstances aggravate the evil in a deed, others excuse or attenuate it. Others may so color the deed that they specify it, make it some special virtue or vice. The circumstance that a murderer is the son of the man he kills specifies the deed as parricide.
3. The end also determines the morality of an action. Since the end is the first thing in the intention of the agent, he passes from the object wished for in the end to choosing the means for obtaining it. Without the end the means cannot exist as such. There are occasions when an end is only a circumstance: for example, if it is a concomitant or extrinsic end. When this extrinsic end is in keeping with right reason or when it is discordant thereto, it may become a determinant of morality. In every voluntary, or human, act there is an interior and exterior act of the will, and each of these acts has its own object. The end is the proper object of the interior act of the will; the exterior object acted upon is the object of the exterior act of the will; both specify the morality, but the interior object or end specifies more importantly, as a rule, than the exterior object does. The will uses the body as an instrument on the external object, and the action of the body is connected with morality only through the will. We judge the morality of a blow not by the physical stroke, but from the intention of the striker. The exterior object of the will is, in a way, the matter of the morality, and the interior object of the will, or the end, is the form. Aristotle said: "He that steals to be able to commit adultery is more of an adulterer than a thief."[1] The thievery is a means to the principal end, and this principal end chiefly specifies or informs the action.
The means used to obtain an end are very important in a consideration of the morality of an act. There are four classes of means—the good, bad, indifferent, and excusable. Good means may be absolutely good, but commonly they are liable to become vitiated by circumstances,—almsgiving is an example. Some means are bad always and inexcusable—lying, for instance. The excusable means are those which are bad, but justifiable through circumstances. To save a man's life by cutting off his leg is an excusable means. The end sometimes may vitiate or hallow indifferent means, but it does not in itself justify all means. Means, like other circumstances, are accidents of an action, but they are in the action just as much as color is in a man. Color is not of a man's essence, but we cannot have a man without color.
The effect of an action, the result or product of an effective cause or agency, may in itself be an end or an object or a circumstance, and it has influence in the determination of morality. Sometimes an act has two immediate effects, one good and the other bad. For example, ligating the blood-vessels going to the uterus to stop a hemorrhage and so save a woman's life, a good effect, has also in ectopic gestation while the fetus is living another immediate effect, namely, to shut off the blood supply from the fetus and so kill it, a bad effect. To make such a double-effect action licit there are four conditions which are explained in the chapter on Mutilation.
The doctrine of Probabilism is very important in morality. Any law must be promulgated before it really becomes a law, and promulgation in a rational conscience is sufficient. Sometimes there is rational doubt of the existence, the interpretation, or the application of a law in a given case. Here probability is the only rule we can follow. A law which is doubtful after honest and capable investigation has not been sufficiently promulgated, and therefore it cannot impose a certain obligation because it lacks an essential element of a law. When we have used such moral diligence as the gravity of the matter calls for, but still the applicability of the law is doubtful in the action in view, the law does not bind; and what a law does not forbid it leaves open. Probabilism is not permissible where there is question of the worth of an action as compared with another, or of issues like the physical consequences of an act. If a physician knows a remedy for a disease that is certainly efficacious and another that is doubtfully efficacious, he may not choose this probable cure. Probabilism has to do only with the existence, interpretation, or applicability of a law, not with the differentiation of actions. The term probable means provable, not guessed at, not jumped at without reason. The doubt must be positive, founded on reason, not a matter of mere ignorance, suspicion, emotional bias. The opinion against a law to permit probabilism must be solid. It must rest upon an intrinsic reason from the nature of the case, or an extrinsic reason from authority, always supposing the authority is really an authority. The probability is to be comparative also. What seems to be a very good reason when standing alone may be weak when compared with reasons on the other side. When we have weighed the arguments on both sides, and we still have a good reason for holding our opinion in a doubtful case, our opinion is probable. The probability is, moreover, to be practical. It must have considered all the circumstances of the case.
There is, then, a Supreme Being whom we must obey, who created and owns human life primarily; there is also a moral law. On these facts rests the argument relating to the destruction of human life. How far, then, has a human being dominion over his own life, and, secondly, over the life of any one else?
St. Thomas,[2] Lessius,[3] and others offer as one argument to prove suicide is not licit, that it is an injury to society or the state of which the suicide is part, and to which the use and profit of his service rightly belong. Lessius, while developing this proof, acknowledges its weakness.
If there were only one man in the world, and no society or state, suicide would still be illicit, because its basic deordination lies deeper than society or the state. If suicide were a moral evil solely because it deprives the state of the suicide's life, then for the same reason no one might become a citizen of another state, emigrate, nor might man abandon society and live as a recluse. Moreover, if a man were detrimental to the state rather than beneficial, in this point of view that fact alone would justify suicide, and the state would then be justified in permitting or even commanding suicide; and we shall show later that the state has not this power.
It is true that the injury done the state or society by loss of use and profit, by scandal and similar evils, is a solid argument against suicide, as such injury aggravates the deordination of suicide, but in itself the injury done to the state and society is not the fundamental reason against suicide.
St. Thomas[4] argues against suicide because it is contrary to the charity a human being should have for himself. This is true ordinarily, and suicide takes on part of its guilt just because it is an offence against the rational regard a person should have for himself; yet this argument is not basic. We are told that if one sins against charity in killing his neighbor, a fortiori he sins in killing himself. Yet suppose just what the advocates of euthanasia suggest, viz., that a neighbor is in great agony and incurable: then the act of killing him takes on a quality of charity rather than of uncharity. And so for the suicide: if the patient is willing to be killed, there would be no uncharity; if he were unwilling, then homicide in any form would be uncharitable and unjust. The argument from charity, therefore, is too narrow to fit the whole case; and its very weakness is a source of error for the advocates of euthanasia.
Still another argument is often advanced against suicide, viz., that a man is obliged to love his own life, since it is the foundation, or the necessary condition, to him, of all good and every virtue, and this circumstance makes the destruction of that life unlawful. That argument has solid truth, but if it held absolutely it would prevent us from desiring death in any case, and no one denies that there are conditions in which a desire for death is fully legitimate. No desire for death, however, can give the slightest justification for the destruction of life.
Again, the argument that suicide is cowardice is not broad enough. Fortitude is a mean between fear and rashness, and this argument maintains that the suicide sins against fortitude by rashness. If we have good reason it is not rash to expose ourselves to death; the soldier may do so, the person struggling to save a neighbor's life, and so on; it may be the highest form of fortitude thus to expose oneself to death. If the suicide can persuade himself that by his act he is seeking greater good than the life he possesses he would have reason for his act, and at least be above cowardice. This argument is one that can be turned at times so as to cut the fingers of the man that uses it. The fundamental reason that suicide is not lawful is that man cannot be master of his own life, and therefore he may not dispose of it as he pleases.
Suicide is the direct killing of oneself on one's own authority. A killing is direct when death is intended as an end, or chosen as a means to an end. Direct killing is positive by commission, or negative by omission. In such cases the will directly rests in the death as a voluntary and free act. A killing is indirect when the act of which death is the effect by its nature and the intent of the agent is directed toward another end, but concomitantly, or as a consequence, results in death. In such case death is an accidental effect, and comes indirectly from the activity of the will—it is not necessarily voluntary. If one has a right to do that other deed, or if it is his duty to do it, and there is a proportion between it and his life, he may do the deed and permit the consequent death.
A direct homicide may be done on one's own authority, or on that of another person. It is done on one's own authority if the agent assumes a natural individual dominion over life, and by virtue of such dominion directly kills himself or another; it is done on the authority of another when a man directly kills himself or another by the mandate of a positive divine or human law, and in the name and on the authority of a positive divine or human legislator. It is evident that God, as Creator, has supreme dominion over human life, and therefore by his positive authority he may command a man directly to kill himself. God, however, does not by the natural law confer on man the right thus to kill. The question here is of the natural duty or right which comes from the natural law alone.
Direct suicide on one's own authority may happen in two ways: positively, that is, by doing an act which is directly homicidal; or negatively, by omitting an act necessary for the preservation of life. That a negative homicide be direct, death must be intended as an end or means. If, however, one voluntarily intends an end or a means, but for the sake of antecedent good or evil omits some act necessary to preserve life, his suicide is indirect, per accidens, and not always illicit unless there is a precept against just such an omission. Man has no dominion over his own life, he has only the use of it; and the natural law obliges us while using a thing which is under the dominion of another not to omit ordinary means for its preservation. We are not, however, held to extraordinary means. His own death is criminally imputable to him who negatively and indirectly kills himself by omitting the ordinary means for preserving his life, because the precept he is under to preserve his own life makes his act voluntary. If he omits extraordinary means, the death is not criminally imputable to him because there is no precept obliging such means. Certain circumstances may by accident oblige one to use extraordinary means to preserve one's own life—a dependent family, a public office in perilous times, or the like. The proposition, then, is: The natural law does not give a man absolute dominion over his own life.
I. The natural law gives no rights except such as are finally founded in human nature itself; but human nature cannot give a title to dominion over one's own life; therefore the natural law does not give man such a right.
Every natural right is either congenital or acquired. The title to a congenital right is human nature itself; the title to an acquired right is some act consequent to the exercise of human activity. The right to such exercise is, in turn, congenital and founded in human nature.
If nature established the title to dominion over one's own life it would thereby establish the power of destroying that life, and thus of removing the fundamental title to all rights; but nature exists as the foundation for rights, not for the subversion of rights; therefore human nature cannot give a final title to dominion over our own life.
Again, this minor of the first argument is confirmed by the fact that if nature even remotely established the power of self-destruction there should be in nature itself some natural tendency to such destruction, but the direct contrary is the fact.
II. The natural law cannot grant a right to man which is not a means to the common end of human life; but absolute dominion over one's own life is not such a means, therefore the natural law cannot give one dominion over his own life.
The natural law is only an ordination of man to that common end of human life and to the means toward that end. As regards the minor of this second argument, an absolute dominion over his own life would give man power to stop all his human activity, yet the common end of human life is attainable only by man's activity. The stopping, or the power of stopping, all activity cannot be a means to that end.
III. The natural law cannot give man a power which is opposed to the essential needs of human nature itself; but that a man should have absolute dominion over his own life is opposed to an essential need of human nature itself, therefore the natural law cannot give such a power.
Dominion over his own life implies the power in man of rebelling against the subjection which he owes to God; but human nature essentially demands that man be in subjection to God, since dominion over one's own life and subjection to God are contradictory.
Again, if man had absolute dominion over his own life he could stand aloof from all influx of the natural law and avoid every duty arising from that law. A law, however, cannot give a power which nullifies itself.
The objection that suicide is licit because no injury can be done a man by an act if the man is willing to submit to the act, is irrelevant. The injury in suicide is not to man at all, but to God.
There is also nothing in the objection that a gratuitous gift may be renounced. Life is not a gratuitous gift; it is an onerous gift with obligations inseparably affixed thereto which forbid the destruction of the gift.
IV. Destruction is an act proper to a master alone. Man cannot be master of his own life; he can have dominion of things that are outside himself, distinguishable from himself, but not of the very existence of himself, which is not really distinguishable from himself. The definition of dominion supposes relation. The offices of master, father, magistrate, are relative conditions which suppose superiority over another person, not over oneself. Even God is not a superior over himself, although he has all perfection. For this reason a man cannot sell himself; he can sell only his labor.
God, who should have absolute dominion over all creatures, and who has, wills to confine these creatures to certain lines of action in keeping with the creature's nature. This is the law underlying even the moral law when it touches humanity; it is the eternal law coeternal with God's decree of creation, but not necessary as God is. When this law exists in the mind of God it is the eternal law; when it exists in the minds of creatures it is the natural law, governing the free acts of intellectual creatures. When the natural law becomes a motive to the human will, obliging but not forcing it, a law through knowledge within the consciousness of a man regulating his behavior, it is called the law of conscience.
Conscience is an act, a practical judgment on one's own action in some particular case. It testifies, accuses, excuses, restrains, urges. It is a rational faculty, not an emotional, sentimental power. Emotion blinds its judgments. Yet mere emotion, and that foolish deordination of emotion called sentimentality, are promptings which the ignorant mistake for conscience and obey. Conscience is the enlightened eye of the heart, not the vagary of any appetite that blunders into action. It must be educated; left to itself, it is guilty of all the perversions of the streets.
The natural law is immutable, not subject to recall by every rascal under the goad of the flesh. In morality what was, is; what was once right because reasonable, always will be right and reasonable. Since opposition to the natural law as applied to man is repugnant to human nature, no power can make opposition to that law licit. For the same reason this law is not subject to evolution. Truth in morality is eternal. What is ugly now was ugly a millennium ago; what was immoral yesterday was immoral in the sixth century. If our ancestors thought permissible what we know to be illicit, our ancestors were ignorant; the fact has not changed. It was as immoral to steal, lie, or murder in the day of Abraham as it is to-day.
The ultimate tendency of man is toward happiness, and, of course, happiness, or any other perfection, is impossible without existence; hence the instinctive recoil from the destruction of our life, which is the requisite condition for happiness. Even those that abnormally destroy their own life do so with horror for the destruction itself, and act thus unreasonably to escape evil, not to escape life; or they seek what they think will be a better life. We can do no other injury to a man so great as the depriving him of his life, for that deprivation destroys every right and possession he has. He can recover from all other evil, or hold his soul above every other evil, but death is the absolute conqueror. No matter how debased or how diseased a man's body may be, no one may dissociate that body from its soul, except in defence of individual or social life under peculiarly abnormal conditions; but even such defence is permissible only while the defender respects other human life and the social life, while he is innocent, has done no harm to society commensurate with the loss of his own life.
"The weariest and most loathed worldly life
That age, ache, penury, and imprisonment
Can lay on nature is a paradise
To what we fear of death."
Existence, no matter how sordid, is immeasurably better than non-existence, for non-existence is nothing; and when we consider eternal life after separation from the body, even as a probability, that raises existence to infinite possibilities above the void of non-existence. A human life, even in an Australian Bushman, in a tuberculous pauper, in the vilest criminal, is in itself so stupendously noble a thing that the whole universe exists for its upholding toward betterment. The raising of human life toward a higher condition has been the sole tendency of all the magnificent charity, sacrifice, patriotism, and heroism the best men and women of the world since time began have striven in. The necessary first cause itself is life, and life is by far the most sacred thing possible for the first cause to effect. Eternal life is the greatest reward of the just.
It is not permissible under any possible circumstance directly to kill an innocent human being. By killing directly is meant either (1) as an end desirable in itself, as when a man is killed for revenge; or (2) as a means to an end. By an innocent human being is meant a person who has not by any voluntary act of his own done harm commensurate with the loss of his own life.
To kill a human being is to destroy human nature, by separating the vital principle from the body; to destroy anything is to subordinate and sacrifice that thing absolutely to the purposes of the slayer; but (1) no one has a right so to subordinate another human being, because man and his life are solely under the dominion of God. If a man may not kill himself, as we proved above, because he is not master of his own life, he surely may not kill another to whom he is no more closely related as master than he is to himself. (2) No man has a right to subordinate another human being as is done in slaying him, because this other human being is a person, an intelligent nature, and consequently free, independent, referring its operations solely to itself as to their centre. This very freedom differentiates man from brutes and inanimate things. These are not independent; they are rightly possessed by man; but man may be possessed by no one except God. Even extrinsic human slavery is abhorrent to us as a corollary of the intrinsic freedom of man, which is absolute. This intrinsic freedom is such that we may not under any circumstances lawfully resign it to another's possession. This is one of the chief moral objections to oath-bound secret societies which exact blind obedience. All morality depends on that freedom, all peace in life, all civilization, and society itself.
The end of our struggles, toil, fortitude, temperance, thrift, is freedom,—freedom to do and to hold, freedom from the thraldom of vice and barbarity. The rational endeavor of every civilized nation is that it be free; and this means solely that every citizen thereof, from the highest to the lowest, is made secure in his rights as a human being. It intends that justice should prevail. Nearly all the unhappiness, crime, moral misery, and much of the physical misery in the world are due to a disregard for liberty, for the safeguarding of men in their inalienable rights. Give every man his bare rights as a man and all troubles of capital and labor, all race problems would cease, the prisons would be empty, war would be unknown. Our struggle toward justice, toward the protection of the rights of man, toward liberty, must go on, or anarchy and social destruction will ensue. Now, as there is nothing greater and nobler than liberty, the freedom of the sons of God to do what they have a right to do, and as every human being has a right to that liberty, so there is nothing baser than its contrary, the destruction of that liberty; and no destruction is so final as that of killing the man, no usurpation so abhorrent to human nature and all liberty. Abhorrence for such a destruction is the primal instinct of all human beings; even the irrational reflexes of our bodies react quickest in protecting us from that destruction.
Justice and order must prevail; that is a fundamental natural law to which all other laws are subordinate. Justice, moreover, is a moral equation, and whenever one right transcends another it must be superior to the right it holds in abeyance. The right an innocent human being has to his life, however, is so great that no other human right can be superior to it while he remains innocent. Subversion of this right by creatures is intrinsically evil, as blasphemy and perjury are evil, although not in exactly the same degree.
There are occasions upon which it is permissible to kill, indirectly, innocent persons. An effect is brought about indirectly when it is neither intended as an end for its own sake, nor chosen as means toward an end, but is attached as a circumstance to the end or the means. Means help to an end, circumstances often do not, although they may affect the morality of an act.
Suppose two swimmers, Peter and Paul, are trying to save Thomas, who dies in the water; as he dies Thomas grips Peter and Paul so tightly that they cannot shake the corpse off. Peter is weak, and he will soon sink and drown, owing to his weakness and the weight of the corpse; Paul also will go down later, owing to the weight of Peter and Thomas. Peter, however, cuts his own clothing loose from the grip of the corpse and is saved; but Paul immediately is drowned, owing to the fact that the full weight of the corpse comes upon him. Is Peter justified in cutting himself loose? Certainly he is. This is an example of indirect killing, a case of double effect, one good, the saving of Peter's life, the other evil, the loss of Paul's life, both proceeding immediately and equally from the causal act, the cutting loose of the clothing. The good effect is intended, the bad effect is reluctantly permitted.
Again, let us set the same condition for Peter, Paul, and Thomas; but Peter is not able to cut himself loose. John, a fourth person, can cut Peter loose and save him, but can do no more; he must let Paul go down with the corpse of Thomas. May John cut Peter loose? Certainly he may, on the principle quod liceat per se licet per alium. This is another case of double effect, with the extenuating circumstances as above.
Suppose, however, Peter represents a living infant in the womb of Ann, and that she is in labor; further, this infant cannot be delivered owing to the contraction of Ann's pelvis. May John, a physician, cut away Peter by craniotomy and so save Ann's life? Certainly he may not. John here directly brains Peter to save Ann, although Peter is not an unjust aggressor; he does a murder to get a good effect, and the end does not justify the means. There are two effects, but the good effect follows from the bad one, and not immediately from the causal act.
Take another example: Peter is a swimmer disabled by cramps and about to drown; Paul, going to save Peter, is seized by Peter, and both are now in danger of drowning; John goes to help Peter and Paul. He cannot get Peter's grip loose by ordinary means, and he sees he can save only one man, either Peter or Paul. May John knock Peter senseless to loosen his grip from Paul, bring in Paul, and thus leave Peter to drown? Certainly he may. You have the double effect here also. Moreover, Peter is a materially unjust aggressor; he is like a maniac trying to kill Paul. In the craniotomy case the child is not a materially or formally unjust aggressor, it is not doing anything at all. It is where the mother put it, and it has a full right to its position and its life.
John most probably might also knock Paul senseless and save Peter, if through affection or similar motive he preferred this course. He would then be justified by the double-effect principle alone, although Paul is in no sense an aggressor. The intention of the blow would have to be solely to loosen Paul's hold.
In a just war a commander may shell an enemy's works and indirectly thereby kill non-combatants. The gunners that cause the death of the non-combatants do not intend this death; they permit it as the evil effect which comes immediately with the good effect (the capture of the works) from the causal act of firing the guns.
If we keep within the bounds of a just defence we may protect ourselves against an unjust aggressor to the effusion of his blood, or even, if need be, to killing him. An aggressor is any one who does injury to us contrary to our rights and the ordination of right. A formally unjust aggressor is a sane intelligent person who intentionally attacks us; a materially unjust aggressor is one who is not intelligent, not responsible, as an insane person, a child, or a sane person who is injuring us unintentionally. This question is important in medicine because the fetus in utero is often erroneously called an unjust aggressor.
It is a primary law of nature that every human being should and will strive to resist injury and destruction. Justice requires a moral equation, and if one right prevails over another it must be superior to the right it supersedes. At the outset both the aggressor and the intended victim have equal rights to life, but the fact that the aggressor uses his own life for the destruction of a fellow man sets the aggressor in a condition of juridic inferiority to the victim. The moral power of the aggressor here is equal to his inborn right to life, less the unrighteous use he makes of it; while the moral power of the intended victim remains in its integrity, and has therefore a higher juridic value.
The right of self-defence is not annulled by the fact that the aggressor is irresponsible. The absence of knowledge saves him from moral guilt, but it does not alter the character of the act considered objectively; it is yet an unjust aggression, and in the conflict the life assailed has still a superior juridic value. In any case the right of wounding or of killing in self-defence is not based on the ill will of the aggressor, but on the illegitimate character of the aggression.
The condition's of a blameless defence (moderamen inculpatae tutelae) are: (1) that the aggressor really threatens the defender's life, and there is no means of offsetting that violence except like violence; (2) that no more violence is used than is adequately required: if the aggression can be stopped by wounding the aggressor the defender is not to kill him; (3) that the violence in the defence is used with the intention of defence, not in revenge, hatred, anger, or the like motives.
We may do an act good in itself from which a double effect immediately follows, one good, to which the agent has a right, and the other bad, which the agent is not obliged to omit if permitted by him and not intended; but in the case of a necessary defence of life against an unjust aggressor, made even with the death of the aggressor, the defence is such an act, provided the moderation of a blameless defence is observed.
The evil effect here is not a means to the good effect, nor does it more immediately follow from the act done. The evil effect is an effect per accidens, and thus not directly voluntary, either in itself, because it is not intended, or in its cause. It lacks the condition necessary to make it voluntary in cause as regards the accidental effect since the act is not prohibited precisely because this accidental effect follows.
The act in the case is good in itself; it is an application of physical force in defence of a proper right, and any right supposes a compulsive power. The two effects of this double-effect act are: (a) the preservation of the defender's life, and (b) the death of the aggressor. The first effect is good because the defender has a right to his own life; the other effect is evil, not only physically for the one who dies, but morally inasmuch as the death conflicts with the dominion of God. This death, however, is an accidental effect of the act, because in general the defensive act is not directed by its nature to that death but to the preservation of the defender's life; nor does the death follow more immediately than the preservation. Thus it is not a means of the defence. Finally, the defensive act is not prohibited precisely lest that death follow: not in justice, for there is no justice in any right of the aggressor which requires from the defender an omission of defence unto the loss of life; there is no obligation in charity, since charity does not oblige us to love another more than ourselves, or to exalt the good of another above our own.
In an aggression which is merely material—say, in an attack by an insane man—the defender has a right to the infliction of such damage as is necessary and proportionate to an efficacious defence. The right of the aggressor yields to the superior right of the defender, not through the fault of the aggressor but through his misfortune. There is a collision where both rights cannot be exercised at the same time, and there is no reason obliging the defendant to forego his own right.
We may defend another against an unjust aggressor because we can assume that the attacked person communicates to us the use of his own coactive right. If the aggressor is our own father, mother, son, or daughter, or in general any one to whom charity obliges us more than to the person attacked, we are not permitted to kill our own kin because charity does not oblige us to prefer the good of an alien to the good of one of our blood. Ordinarily we are not obliged in justice or charity to defend another at the risk of our own life.
We may kill an unjust aggressor, servatis servandis, in defence of good equivalent in value to life: for example, to prevent life imprisonment, the loss of reason, a mutilation which would render us useless, the loss of a woman's chastity.
There are cases of accidental homicide, in medicine and elsewhere, which have an element of guilt in them. If a death follows accidentally upon an act which in itself is licit, and the agent uses all proper precautions, he is not morally guilty in case of an accidental death following his act. This is true even if the agent foresaw a probable death but did not intend it. If, however, the agent's primary act is illicit in itself, and an accidental death follows from this act, the agent may be guilty of homicide, provided the first act in itself is naturally likely to cause homicide. Should the first act be always dangerous, such that death commonly follows from it, like rocking a row-boat, aiming a supposedly unloaded gun at a person and pulling the trigger, striking a pregnant woman, drinking whiskey and then overlying an infant in the bed, throwing building material from a roof to a street, racing an automobile through a crowded thoroughfare, sending a crew out in a rotten ship, and so on, the accidental homicide that follows is imputable to the agent no matter how much precaution he may say he has used to avert such a death.
Suppose, secondly, the original act of the agent is illicit but such that accidental death rarely follows from it; then if he takes due precaution he is not ordinarily guilty of homicide. He has, say, stolen an automobile, and is going along the street leisurely, when a careless child runs off the sidewalk under the machine and is killed.
1. No person, then, may hasten his own death or permit any one else to hasten it.
2. No physician may in any possible condition kill a patient merely to effect euthanasia.
3. The state has no more right than the physician to permit the killing of patients to bring about euthanasia.
Were such permission given to physicians it would immediately be abused by men with even the best intentions. In all countries and in the largest cities the medical profession is swarming with quacks. What is done in crass ignorance by licensed physicians and specialists every day in the name of medicine is appalling. Professor Orth of the Pathologic Institute in Berlin makes the statement that of all the appendices that have been submitted to him for microscopic examination after removal by conservative and supposedly skilled physicians, 17 per cent. showed no disease at all, and should not have been removed. In this country the percentage of normal appendices removed because of vague abdominal pains is much larger.
The Journal of the American Medical Association (June 7, 1913) gave a list of post-mortem examinations where the diagnosis made by men with a reputation for fair work had been correct in only the following ratios:
| Diagnosis | Diagnosis | |
| correct. | incorrect. | |
| Per cent. | Per cent. | |
| Diabetes Mellitus | 95 | 5 |
| Typhoid Fever | 92 | 8 |
| Aortic Regurgitation | 84 | 16 |
| Cancer of Colon | 74 | 26 |
| Lobar Pneumonia | 74 | 26 |
| Chronic Glomerular Nephritis | 74 | 26 |
| Cerebral Tumor | 72.8 | 27.2 |
| Tuberculous Meningitis | 72 | 28 |
| Gastric Cancer | 72 | 28 |
| Mitral Stenosis | 69 | 31 |
| Brain Hemorrhage | 67 | 33 |
| Septic Meningitis | 64 | 36 |
| Aortic Stenosis | 61 | 39 |
| Phthisis, Active | 59 | 41 |
| Miliary Tuberculosis | 52 | 48 |
| Chronic Interstitial Nephritis | 50 | 50 |
| Thoracic Aneurism | 50 | 50 |
| Hepatic Cirrhosis | 39 | 61 |
| Acute Endocarditis | 39 | 61 |
| Peptic Ulcer | 36 | 64 |
| Suppurative Nephritis | 35 | 65 |
| Renal Tuberculosis | 33.3 | 66.7 |
| Bronchopneumonia | 33 | 66 |
| Vertebral Tuberculosis | 23 | 77 |
| Chronic Myocarditis | 22 | 78 |
| Hepatic Abscess | 20 | 80 |
| Acute Pericarditis | 20 | 80 |
| Acute Nephritis | 16 | 84 |
Pneumonia is a very common disease, extremely dangerous, and by skilful treatment it is very often cured, yet of these 100 cases 66 were not diagnosed. I recently saw a severe case of double pneumonia which a physician was treating as "indigestion," and he was giving pepsin tablets for the supposed indigestion. There is such a thing as extraordinary scientific precision in medical work, but it is rare; the ordinary physician treats symptoms without knowing the cause of the symptoms; that is, the symptom-treater is a quack, and if euthanasia were legalized thousands of such quacks would be permitted to murder with an overdose of morphine any querulous old man or woman who might fall into their hands. Osteopaths and chiropractors are masseurs, and they know very little of massage, but they are licensed by legislatures to practise medicine, and some of them even try obstetrical malpractice. They, too, would be licensed to inflict euthanasia. Pure homeopathy is little more than a name at present; it is faith-healing without prayer. It attenuates its drugs 100 per cent. for thirty repetitions, to a degree expressible by one with sixty ciphers. Consequently it gives sugar of milk or alcohol in minute quantities plus a label, and one cannot make much of an impression on any disease with a label. Such practitioners also would come under the euthanasia act.
BIBLIOGRAPHY
Cardinal John de Lugo. Disputationes Scholasticae et Morales, vol. vi; De Justitia et Jure, disputatio x.
St. Augustine. I Contra Petilianum, cap. 24; Ad Marcellianum Comitem, cap. 21; De Civitate Dei, cap. 17 to 28.
Aristotle. III Ethicorum, cap. 7, and lib. v, cap. ii. Plato. Phaedo.
Cicero. Quaestiones Tusculanae. I, lib. v; De Somno Scipionis.
Lessius. De Justitia et Jure, lib. ii, c. 9, dub. 6, 7.
Molina. De Justitia et Jure, vol. i, tr. 2, disp. 119; vol. iv, tr. 3, disp. 1 and 9.
St. Thomas Aquinas. Summa Theologica, 2, 2, q. 64, a. 5, 7.
St. Alphonsus Liguori. Theologia Moralis, vol. iv, tr. 4. See this book for opposed opinions and a bibliography.
Costa-Rossetti. Philosophia Moralis, thesis 120.
Ferretti. Philosophia Moralis, theses xci, xciv.
Macksey. De Ethica Naturali, theses xxxiv et seq.